Acute High-Intensity Intermittent Aerobic Exercise Reduces Plasma Angiopoietin-Like 2 in Patients With Coronary Artery Disease

Background: Circulating levels of angiopoietin-like 2 (ANGPTL2), a proinflammatory and proatherogenic protein, are elevated in patients with coronary artery disease (CAD). We hypothesized that highintensity intermittent exercise (HIIE), known to be beneficial in patients with CAD, would reduce circulating ANGPTL2 levels. Methods: Plasma levels of ANGPTL2 were measured before and 20 minutes, 24 hours, and 72 hours after an acute exercise session in a crossover study comparing HIIE to moderate-intensity continuous exercise (MICE) in 14 patients with CAD and 20 age-matched and 20 young healthy controls. Results: Pre-exercise ANGPTL2 levels were 3-fold higher in patients with CAD than in age-matched controls (P < 0.05) and correlated negatively with Vo(2max)/lean body mass (P < 0.0001). In healthy controls, ANGPTL2 levels were low and not affected by HIIE or MICE. In patients with CAD, ANGPTL2 levels decreased significantly by 41% after 20 minutes of HIIE, a reduction that was maintained after 24 and 72 hours (P < 0.05). In contrast, although ANGPTL2 levels decreased by 47% after 20 minutes of MICE, they increased by 104% after 24 hours and returned to baseline values after 72 hours (P < 0.05). A negative correlation was observed between this increase in ANGPTL2 levels and the mean rate- pressure product (heart rate x systolic blood pressure; index of myocardial O-2 consumption) measured during MICE, suggesting that subclinical ischemia might promote ANGPTL2 expression. Conclusions: In patients with CAD, circulating ANGPTL2 levels are acutely reduced after HIIE and transiently increased after MICE. A sustained reduction in circulating ANGPTL2 levels could contribute to the chronic beneficial cardiometabolic effects of HIIE in patients with CAD.