Cardiovascular diseases, cold exposure and exercise

Abstract

Both acute and prolonged cold exposure affect cardiovascular responses, which may be modified by an underlying cardiovascular disease. In addition, exercise in a cold environment increases cardiovascular strain further, but its effects among persons with cardiovascular diseases are not well known. Controlled studies employing whole-body or local cold exposure demonstrate comparable or augmented increase in cardiac workload, but aggravated cutaneous vasoconstriction in persons with mild hypertension. A strong sympathetic stimulation of a cold pressor test, increases cardiac workload in persons with coronary artery disease (CAD), but does not markedly differ from those with less severe disease or healthy. However, cold exposure reduces myocardial oxygen supply in CAD, which may lead to ischemia. Exercise in cold often augments cardiac workload in persons with CAD more than when performed in thermoneutral conditions. At the same time, reduced myocardial perfusion may lead to earlier ischemia, angina and impaired performance. Also having a heart failure deteriorates submaximal and maximal performance in the cold. Antianginal medication is beneficial in the cold in lowering blood pressure, but does not affect the magnitude of coldrelated cardiovascular responses in hypertension. Similarly, the use of blood pressure lowering medication improves exercise performance in cold both among persons with CAD and heart failure. Both the acute and seasonal effects of cold and added with exercise may contribute to the higher morbidity and mortality of those with cardiovascular diseases. Yet, more controlled studies for understanding the pathophysiological mechanisms behind the adverse cold-related health effects are warranted.

Cold‐induced cutaneous vasoconstriction in humans: Function, dysfunction and the distinctly counterproductive

“…reduced shivering and non-shivering thermogenesis; Falk et al, 1994;Wagner, Robinson, & Marino, 1974) (Gao, Wilson, Drew, Ettinger, & Monahan, 2012;Ikaheimo, 2018). reduced shivering and non-shivering thermogenesis; Falk et al, 1994;Wagner, Robinson, & Marino, 1974) (Gao, Wilson, Drew, Ettinger, & Monahan, 2012;Ikaheimo, 2018).…”

“…Additional factors that contribute to the age-associated increased risk of hypothermia include an impaired ability to increase metabolic heat production (i.e. reduced shivering and non-shivering thermogenesis; Falk et al, 1994;Wagner, Robinson, & Marino, 1974) (Gao, Wilson, Drew, Ettinger, & Monahan, 2012;Ikaheimo, 2018). However, for the purpose of this review, we will focus on alterations in neurovascular function that limit cold-induced vasoconstriction in healthy ageing.…”

“…Although this is attributable, in part, to the baseline elevated blood pressure in these individuals, acute vascular responses to cold also appear to be augmented, which compounds the problem and contributes to the increased cardiovascular risk. Although the exaggerated pressor response to skin cooling is well documented in the peripheral circulation, the reduced arterial compliance and increased aortic stiffness associated with hypertension might also exaggerate the increase in central aortic blood pressure and elevate the risk of adverse cardiovascular events during cold exposure (Ikaheimo, 2018).…”

Endothelial function in response to exercise in the cold in patients with coronary artery disease

“…Cold exposure increases cardiovascular strain as a result of reflex and/or local cooling‐induced cutaneous vasoconstriction and related higher peripheral resistance elevating blood pressure and increasing cardiac workload (Castellani & Young, 2016; Johnson, Minson, & Kellogg, 2014). Cold‐related cardiovascular events may be more common among persons with coronary artery disease (CAD) due to their reduced vascular responsiveness and lesser ability for coronary vasodilation in response to higher myocardial oxygen demand (Ikäheimo, 2018; Manou‐Stathopoulou et al, 2015). Regular exercise is effective in the treatment of coronary artery disease (CAD) and in preventing its progress, alleviating its symptoms, as well as reducing the risk of myocardial infarction or fatal cardiac event (Anderson et al, 2016).…”

“…Regular exercise is effective in the treatment of coronary artery disease (CAD) and in preventing its progress, alleviating its symptoms, as well as reducing the risk of myocardial infarction or fatal cardiac event (Anderson et al, 2016). However, as both exercise and cold exposure increase cardiac workload, it is not well established whether their combination would increase the risk for adverse cardiovascular events (Ikäheimo, 2018; Manou‐Stathopoulou et al, 2015; Valtonen et al, 2018). For example, sudden heavy exercise, such as snow shovelling, triggers cardiac events in patients with ischaemic heart disease (Janardhanan et al, 2010; Toukola et al, 2015).…”