Cardiac rehabilitation programme as a non-pharmacological platelet inhibitory tool in acute coronary syndrome survivors

Abstract

Background

Acute coronary syndrome is associated with platelet hyperactivity, which in its persistent form, promotes recurrent thrombotic events. Complex cardiac rehabilitation after acute coronary syndrome improves clinical outcome; however, its effect on platelet hyperactivity is unknown.

Design and methods

We enrolled 84 acute coronary syndrome patients on dual antiplatelet therapy, who underwent a new complex cardiac rehabilitation programme (NovaCord physiotherapy, lifestyle counselling, strict diet, stress management and regular coaching) and 51 control acute coronary syndrome patients with traditional cardiac rehabilitation. Platelet functionality was determined at enrolment and at three months follow-up by aggregometry, serum platelet-derived growth factor levels, total- and platelet-derived microvesicle counts (PMV; CD41a+/CD61+, CD62P+).

Results

Platelet aggregation parameters and platelet-derived growth factor levels were significantly decreased in the complex cardiac rehabilitation group at three months (1 µg/ml collagen, median (interquartile range): 22 (10–45) vs 14 (7.5–25.5)%, p = 0.0015; 2 µg/ml collagen: 36 (22–60) vs 26.5 (16–37)%, p = 0.0019; 1.25 µM adenosine-diphosphate: 4.5 (1–10) vs 1 (0–3)%, p = 0.0006; 5 µM adenosine-diphosphate: 27 (16–38) vs 22 (12–31)%, p = 0.0078; epinephrine: 33 (15–57) vs 27 (12–43)%, p = 0.01; platelet-derived growth factor: 434.6 (256.0–622.7) vs 224.8 (148.5–374.1) pg/ml, p = 0.0001). In contrast, these changes were absent or did not reach statistical significance in the traditional cardiac rehabilitation group. Platelet–derived microvesicle counts were significantly decreased in both groups, while total microvesicle count was significantly reduced only in the complex cardiac rehabilitation group (median (interquartile range): 3945.5 (2138–5661) vs 1739 (780–2303) count/µl; p = 0.0001).

Conclusions

Platelet hyperactivity three months after acute coronary syndrome significantly decreased in patients undergoing complex cardiac rehabilitation. Besides dual antiplatelet therapy, effective management and comprehensive control of cardiovascular risk factors might represent a new, non-pharmacological approach to influence platelet functionality.

Keywords

Acute coronary syndromes cardiac rehabilitation dual antiplatelet therapy platelet hyperactivity platelet aggregation platelet-derived microvesicles platelet-derived growth factor

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References

Davì

Patrono

. Platelet activation and atherothrombosis. N Engl J Med 2007; 357: 2482–2494.

Merlini

Bauer

Oltrona

. Persistent activation of coagulation mechanism in unstable angina and myocardial infarction. Circulation 1994; 90: 61–68.

Trip

Cats

van Capelle

. Platelet hyperreactivity and prognosis in survivors of myocardial infarction. N Engl J Med 1990; 322: 1549–1554.

Geisler

Langer

Wydymus

. Low response to clopidogrel is associated with cardiovascular outcome after coronary stent implantation. Eur Heart J 2006; 27: 2420–2425.

Breet

van Werkum

Bouman

. Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation. JAMA 2010; 303: 754–762.

Barry

Pratico

Lawson

. Transcellular activation of platelets and endothelial cells by bioactive lipids in platelet microparticles. J Clin Invest 1997; 99: 2118–2127.

Skeppholm

Mobarrez

Malmqvist

. Platelet-derived microparticles during and after acute coronary syndrome. Thromb Haemost 2012; 107: 1122–1129.

Piepoli

Hoes

Agewall

. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–2381.

Chow

Jolly

Rao-Melacini

. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010; 121: 750–758.

10.

Gaalema

Savage

Rengo

. Patient characteristics predictive of cardiac rehabilitation adherence. J Cardiopulm Rehabil Prev 2017; 37: 103–110.

11.

Anderson

Thompson

Oldridge

. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2016; 1: CD001800–CD001800.

12.

Agewall S, Albus

Piepoli

. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23: NP1–NP96.

13.

Gaalema DE, Elliott RJ, Morford ZH, et al. Effect of socioeconomic status on propensity to change risk behaviors following myocardial infarction: Implications for healthy lifestyle medicine. Prog Cardiovasc Dis 2017.

14.

Bonello

Tantry

Marcucci

. Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J Am Coll Cardiol 2010; 56: 919–933.

15.

Neubauer

Lask

Engelhardt

. How to optimise clopidogrel therapy? Reducing the low-response incidence by aggregometry-guided therapy modification. Thromb Haemost 2008; 99: 357–362.

16.

Sabouret

Rushton-Smith

Kerneis

. Dual antiplatelet therapy: Optimal timing, management, and duration. Eur Heart J Cardiovasc Pharmacother 2015; 1: 198–204.

17.

Scalone

Coviello

Barone

. Evidence of increased platelet reactivity in the first six months after acute ST segment elevation myocardial infarction. Thromb Res 2011; 128: 174–178.

18.

Marcucci

Valente

Gori

. Global platelet hyperreactivity and elevated C-reactive protein levels predict long term mortality in STEMI patients. Thromb Res 2014; 134: 884–888.

19.

FitzGerald

Oates

Nowak

. Cigarette smoking and hemostatic function. Am Heart J 1988; 115: 267–271.

20.

Wang

Chen

. Effects of exercise training and deconditioning on platelet aggregation induced by alternating shear stress in men. Arterioscler Thromb Vasc Biol 2005; 25: 454–460.

21.

Pieters

de Maat

. Diet and haemostasis – a comprehensive overview. Blood Rev 2015; 29: 231–241.

22.

Ricci

Ferri

. Naturally occurring PDGF receptor inhibitors with potential anti-atherosclerotic properties. Vascul Pharmacol 2015; 70: 1–7.

23.

Boulanger

Amabile

Tedgui

. Circulating microparticles: A potential prognostic marker for atherosclerotic vascular disease. Hypertension 2006; 48: 180–186.

24.

Michelsen

Brodin

Brosstad

. Increased level of platelet microparticles in survivors of myocardial infarction. Scand J Clin Lab Invest 2008; 68: 386–392.

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