CENIT (Impact of Cardiac Exercise Training on Lipid Content in Coronary Atheromatous Plaques Evaluated by Near‐Infrared Spectroscopy): A Randomized Trial

Abstract

Background The effect of physical exercise on lipid content of coronary artery plaques is unknown. With near infrared spectroscopy we measured the effect of high intensity interval training (HIIT) on lipid content in coronary plaques in patients with stable coronary artery disease following percutaneous coronary intervention. Methods and Results In CENIT (Impact of Cardiac Exercise Training on Lipid Content in Coronary Atheromatous Plaques Evaluated by Near‐Infrared Spectroscopy) 60 patients were randomized to 6 months supervised HIIT or to a control group. The primary end point was change in lipid content measured as maximum lipid core burden index at 4 mm (maxLCBI 4mm ). A predefined cutoff of maxLCBI 4mm >100 was required for inclusion in the analysis. Forty‐nine patients (HIIT=20, usual care=29) had maxLCBI 4mm >100 at baseline. Change in maxLCBI 4mm did not differ between groups (−1.2, 95% CI, −65.8 to 63.4, P =0.97). The estimated reduction in maxLCBI 4mm was −47.7 (95% CI, −100.3 to 5.0, P =0.075) and −46.5 (95% CI, −87.5 to −5.4, P =0.027) after HIIT and in controls, respectively. A negative correlation was observed between change in peak oxygen uptake (VO 2peak ) and change in lipid content (Spearman’s correlation −0.44, P =0.009). With an increase in VO 2peak above 1 metabolic equivalent task, maxLCBI 4mm was on average reduced by 142 (−8 to −262), whereas the change was −3.2 (154 to −255) with increased VO 2peak below 1 metabolic equivalent task. Conclusions Six months of HIIT following percutaneous coronary intervention did not reduce lipid content in coronary plaques compared with usual care. A moderate negative correlation between increase in VO 2peak and change in lipid content generates the hypothesis that exercise with a subsequent increase in fitness may reduce lipid content in coronary atheromatous plaques. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02494947.

Exercise Intensity and Coronary Plaque Composition: Is Harder, Better, Faster, Stronger?

“…As atherosclerosis is a systemic disease, the totality of clinical benefit is likely underestimated. Taken together, despite the negative study, we congratulate Vesterbekkmo and colleagues 13 as well as their patients for reporting these important data. Plaque imaging research and physical activity science are both challenging domains.…”

“…For clarity, data are binned, with mean changes redrawn from Nishitani‐Yokoyama (2018) 11 and Vesterbekkmo (2022). 13 ACS indicates acute coronary syndrome; and CAD, coronary artery disease.…”

“…In this issue of the Journal of the American Heart Association ( JAHA ), Vesterbekkmo and colleagues 13 report the findings of the CENIT (Impact of Cardiac Exercise Training on Lipid Content Coronary Atheromatous Plaque Evaluated by Near‐Infrared Spectroscopy—A Randomized Trial). The investigators used intracoronary near infrared spectroscopy to examine whether supervised high intensity interval training (HIIT) modified coronary plaque lipid content relative to unsupervised exercise with standard counseling.…”

Associations between circulating microRNAs and lipid-rich coronary plaques measured with near-infrared spectroscopy

“…From the 60 included patents in the CENIT trial 19 , 13 patients were excluded from the present study due to non-evaluable NIRS data (no non-culprit plaques), missing blood samples, or disregarded plasma samples based on quality control tests (Supplementary Figure S1 ). This yielded 47 eligible patients for statistical analyses.…”

“…This post-hoc study used baseline data from the randomized controlled trial Impact of Cardiac Exercise Training on Lipid Content in Coronary Atheromatous Plaques Evaluated by Near-Infrared Spectroscopy (CENIT) 19 . The trial was registered at clinicaltrials.gov (NCT02494947), approved by the ethical committee of central Norway (2015/210), and performed in accordance with the Declaration of Helsinki.…”