title: Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease: A randomized trial.
abstract: BACKGROUND
  Dyslipidemia and low-grade inflammation are integral in the pathogenesis of atherosclerosis. We aim to compare the effects of a considerable weight loss and intensive exercise training on lipid atherogenicity and low-grade inflammation in a high-risk population with coronary artery disease (CAD).
  
  
  METHODS
  Seventy non-diabetic participants with CAD, BMI 28-40 kg/m(2), age 45-75 years were randomized to 12 weeks' aerobic interval training (AIT) at 85-90% of peak heart rate three times/week or a low energy diet (LED, 800-1000 kcal/day) for 8-10 weeks followed by 2-4 weeks' weight maintenance diet. Lipid profile atherogenicity was described using lipoprotein particle size and density profiling. Low-grade inflammation was evaluated by tumor necrosis factor alpha (TNFα), C-reactive protein, interleukin 6 and soluble urokinase plasminogen activator receptor.
  
  
  RESULTS
  Twenty-six (74%) AIT and 29 (83%) LED participants completed intervention per protocol. AIT and LED decreased total (AIT: -518 {-906;-129},P = 0.011, LED: -767 {-1128:-406},P < 0.001) and low-density lipoprotein (LDL, AIT: -186 {-306;-65},P = 0.004, LED: -277 {-433;-122},P < 0.001) assessed as the area under the density profile curve. LED was superior to AIT in decreasing atherogenicity reflected by increased LDL (between-group: 1.0 Å {0.4; 1.7},P = 0.003) and high-density lipoprotein (between-group: 1.2 Å {0.2; 2.4},P = 0.026) particle size and a decreased proportion of total lipoprotein constituted by the small, dense LDL5 subfraction (between-group: -5.0% {-8.4;-1.7},P = 0.004). LED decreased TNFα (9.5% {-15.8;-2.6},P = 0.009). No changes were seen following AIT.
  
  
  CONCLUSIONS
  LED and AIT decreased total and LDL lipoprotein. LED was superior in decreasing atherogenicity assessed by a shift in density profile and increased particle size. Effect on low-grade inflammation was limited.
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: lrpedersen@gmail.com.
authors.forename: Lene Rørholm
authors.initials: LR
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rasmus Huan
authors.initials: RH
authors.lastname: Olsen
authors.affiliation: Department of Internal Medicine, Hvidovre and Amager University Hospitals, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Anholm
authors.affiliation: Faculty of Nutrition, Texas A&M University, College Station, TX, USA.
authors.forename: Rosemary L
authors.initials: RL
authors.lastname: Walzem
authors.affiliation: Department of Medical Biochemistry, Genetics and Molecular Biochemistry, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Fenger
authors.affiliation: Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Eugen-Olsen
authors.affiliation: Department of Internal Medicine, Hvidovre and Amager University Hospitals, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Steen Bendix
authors.initials: SB
authors.lastname: Haugaard
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D031204:Caloric Restriction; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003718:Denmark; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D018836:Inflammation Mediators / Q000097:blood; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D057185:Sedentary Behavior; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D008055:Lipids
keywords: Atherogenesis; Coronary artery disease; Exercise; Inflammatory markers; Lipoproteins; Weight loss