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LETTER TO THE EDITOR

Commentary on Viewpoint: Exercise and cardiovascular risk reduction: Time to update the rationale for exercise?

TO THE EDITOR: The article by Green et al. (3) emphasizes a critical problem for cardiovascular disease risk assessment and management: the limitations of current risk factors as a measure of vascular health. Fortunately, researchers, including Green and colleagues, continue to address this issue while the mechanisms of cardiovascular disease are studied. Unfortunately, big breakthroughs in this area have yet to be uncovered. A recent study by Wang et al. (4) found that the use of multiple biomarkers based on current cardiovascular risk factors added just moderately to the prediction of cardiovascular events and death. Future research focusing on contemporary cardiovascular risk factors such as endothelial function and serum biomarkers will ultimately lead to improved risk assessment. Brachial artery flow-mediated dilation, an assessment of endothelial function, was an independent predictor of cardiovascular risks in patients with established vascular disease (2). Testing endothelial function has great potential for cardiovascular risk assessment and disease management. However, substantial progress is needed before such tools as flow-mediated dilation may be used for cardiovascular risk assessment (1). It is noteworthy of authors to point out that exercise, similar to pharmacological interventions, may have differential effects for healthy individuals compared with those with certain risk factors or disease. Similarly, studies of endothelial function in individuals without known cardiovascular disease have reported mixed results (1). More work is to be done especially in open areas of endothelial function research that include healthy cohorts as well as diseased. In the meantime, update the rationale for exercise!

FOOTNOTES

Address for reprint requests and other correspondence: M. Elliott, 3307 N. Broad St., Jones Hall 6th Floor, Philadelphia, PA 19140 (e-mail: mdion{at}temple.edu)

REFERENCES

1. Anderson TJ. Prognostic significance of brachial flow-mediated vasodilation. Circulation 115: 2373–2375, 2007.[Free Full Text]
2. Brevetti G, Silvestro A, Schiano V, Chiarello M. Endothelial dysfunction and cardiovascular risk prediction in peripheral arterial disease. Circulation 108: 2093–2098, 2003.[Abstract/Free Full Text]
3. Green DJ, Driscoll GO, Joyner MJ, Cable NT. Viewpoint: Exercise and cardiovascular risk reduction: time to update the rationale for exercise? J Appl Physiol; doi:10.1152/japplphysiol.010128.2007.[CrossRef]
4. Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C, Jacques PF, Rifai N, Selhub J, Robins SJ, Benjamin EJ, D'Agostino, Vasan RS. Multiple biomarkers for the prediction of first major cardiovascular events and death. New Engl J Med 355: 2631–2639, 2006.[Abstract/Free Full Text]

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