An Elevated Level of Physical Activity Is

Associated With Normal Lipoprotein(a) Levels in

Individuals From Maracaibo, Venezuela

Valmore Bermudez, MD, MPH, PhD,1* Daniel Aparicio, BSc,1 Edward Rojas, BSc,1

Lianny Penaranda, BSc,1 Freddy Finol, BSc,1 Luis Acosta, BSc,1

Edgardo Mengual, MD,1 Joselyn Rojas, MD,1 Nailet Arraiz, MSc, PhD,1

Alexandra Toledo, BSc,1 Carlos Colmenares, BSc,1 Jesica Urribarı, BSc,1

Wireynis Sanchez, BSc,1 Carlos Pineda, BSc,1 Dalia Rodriguez, BSc,1

Judith Faria, BSc,1 Roberto Anez, BSc,1 Raquel Cano, MD, MgSc,1

Clımaco Cano, PharmD,1 Luis Sorell, PhD,2 and Manuel Velasco, MD, FRCP Edin3

Coronary artery disease is the main cause of death worldwide. Lipoprotein(a) [Lp(a)], is an independentrisk factor for coronary artery disease in which concentrations are genetically regulated. Contradictoryresults have been published about physical activity influence on Lp(a) concentration. This research aimedto determine associations between different physical activity levels and Lp(a) concentration. A descriptiveand cross-sectional study was made in 1340 randomly selected subjects (males = 598; females = 712) towhom a complete clinical history, the International Physical Activity Questionnaire, and Lp(a) leveldetermination were made. Statistical analysis was carried out to assess qualitative variables relationshipby x2 and differences between means by one-way analysis of variance considering a P value ,0.05 asstatistically significant. Results are shown as absolute frequencies, percentages, and mean 6 standarddeviation according to case. Physical activity levels were ordinal classified as follows: low activity with24.3% (n = 318), moderate activity with 35.0% (n = 458), and high physical activity with 40.8% (n = 534).Lp(a) concentration in the studied sample was 26.28 6 12.64 (IC: 25.59–26.96) mg/dL. Lp(a) con-centration according to low, moderate, and high physical activity levels were 29.22 6 13.74, 26.27 6 12.91,and 24.53 6 11.35 mg/dL, respectively, observing statistically significant differences between low andmoderate level (P = 0.004) and low and high level (P , 0.001). A strong association (x2 = 9.771; P = 0.002)was observed among a high physical activity level and a normal concentration of Lp(a) (less than30 mg/dL). A lifestyle characterized by high physical activity is associated with normal Lp(a) levels.

Keywords: physical activity, lipoprotein(a), lifestyle, cardiovascular risk

INTRODUCTION

Cardiovascular diseases constitute one of the maincauses of death in the adult population worldwide, butit was not always like this. Less than three decades ago,prevention and control of conditions related tocardiovascular and cerebrovascular diseases were not

the priority. In fact, they were considered industrializedcountries diseases, often labeled the ‘‘Westernizedlifestyle diseases’’ as a result of their distinct character-

istics that were far from the usual traits seen in thedeveloping countries. Today, they are a high-priority

1Endocrine and Metabolic Diseases Research Center ‘‘Dr. FelixGomez,’’ School of Medicine, University of Zulia, Maracaibo,Venezuela; 2Angiology and Vascular Surgery Institute, GeneticEngineering and Biotechnology Center, La Habana, Cuba; and3Clinical Pharmacology Unit, Vargas Medical School, CentralUniversity of Venezuela, Caracas, Venezuela.This work was supported by research grant No. S1-2002000445from the National Fund for Science, Technology and Innovation(FONACIT), Ministerio del Poder Popular para la Ciencia y laTecnologıa, Republica Bolivariana de Venezuela.*Address for correspondence: The University of Zulia, Endocrine andMetabolic Diseases Research Center, 20th Avenue, Maracaibo, 4004,Venezuela. E-mail: valmore@gmail.com; ciemfelixgomez@gmail.com

American Journal of Therapeutics 17, 341–350 (2010)

1075–2765 � 2010 Lippincott Williams & Wilkins www.americantherapeutics.com

problem in the agenda of almost every country in theworld, including the developing countries. By 2001, thetotal death toll for nontransmissible diseases was up to32 millions, of which almost its half—16.7 million—were the result of cardiovascular diseases.1 Venezueladoes not escape this reality. According to the yearbookof mortality, by 2006, more than 28% of the diagnoseddeaths were the result of cardiovascular disease, withcardiac problems the first cause of death (20.63%) andcerebrovascular disease the fourth (7.76%).2

Traditionally, the main risk factors for coronaryartery disease are smoking habit, Westernized diet, andsedentary lifestyle, all of these expressed in a phenotypecharacterized by an unfavorable lipid profile, hyper-glycemia, elevated body mass index, and high bloodpressure. It has been argued that these factors explainat least 75% of the new cases of coronary disease.1,3

Today, new risk factors have emerged4 and havebeen identified and analyzed; such is the case of theunique lipoprotein(a) [Lp(a)]. Investigations show thathigh concentrations of this particle are associated withthree- or fourfold risk for myocardial infarction5,6 andischemic cerebrovascular disease,7–9 although somestudies have shown controversial results.10 Ability ofLp(a) to enhance cardiovascular risk is the result of itsatherogenic and pro-thrombotic properties,11 as a resultof its similarity to the low-density lipoprotein particleand structural homology to plasminogen, but lackingits fibrinolytic activity.

It is worth commenting that there is no consensusdefining the cutoff values of Lp(a), but commonlya value of 30 mg/dL or greater has been used. Yet,many authors believe that levels above 25 mg/dL areimportant predictors of cardiovascular risk; yet evensome consider accepting a 20-mg/dL level as a high-risk cutoff point.12

A sedentary lifestyle constitutes an independent andmodifiable risk factor for cardiovascular disease. Thereis not a clear definition on what a sedentary lifestyle isor what an active lifestyle is. Some authors definea sedentary person as one who invests a low amount ofminutes during the day for activities during their freetime,18 activity that would actually consume 4 metabolicequivalent tasks (METs), with minimal time activity forexecution, which has been established as 25 minutes forwomen and 30 minutes for men. Other authors define itas someone who invests less than 10% of their dailyenergy consumption doing physical activity that requires4 or more METs (any physical activity equivalent or supe-rior to walking fast). A MET is the energy consumption ofan individual at rest, which is approximately 1 kcal/kg/hour, meaning, 4.184 kJ/kg/hour.14 This concept hasbeen useful in the measurement of physical activity level,making it accepted and applied worldwide.

Meanwhile, the benefits of physical activity havebeen extensively documented.14 Various studies showthat regular physical activity lowers fasting andpostprandial glycemia and insulin resistance,15,16 bodymass index,17 and elevated blood pressure.18 Likewise,it positively influences parameters in the lipid profile,like elevating high-density lipoproteins, lowering low-density lipoprotein cholesterol, and triglycerides.19

Although the beneficial effects of exercise in thecardiovascular area have been widely documented, therelationship between physical activity and Lp(a)concentration has not been well studied. Thus, thepurpose of this study was to determine the associationbetween Lp(a) and physical patterns in individualsfrom an urban population from Venezuela.

MATERIALS AND METHODS

Study design

A cross-sectional and comparative study was made in1310 adult individuals, 712 females (54.4%) and 598males (45.6%), randomly selected from MaracaiboDistrict, Zulia State, Venezuela, during the periodAugust 2007 to March 2009 to whom previousinformed written consent, a complete medical historywas made, and the Long Form of the InternationalPhysical Activity Questionnaire (IPAQ) was applied.After 8 to 12 hours of fasting, all patients underwentvenous blood sampling to determine Lp(a) concentra-tion. This work is part of a large cross-sectional studyconducted by our center, ‘‘The Maracaibo CityMetabolic Syndrome Study.’’

According to the 2001 Venezuelan population census,the population of Maracaibo District was of 1,219,927habitants20 with a 2007 estimate of 1,428,043 people.Likewise, 59.7% of the population will be made ofindividuals older than 18 years of age. To take thesedata as accurate, the size needed for the requiredpopulation sample for a confidence level of 99% anda fixed error limit of 3.5% is 1399 individuals with ages18 years old or older.

Statistical analysis

Statistical analysis was done using Statistical Packagefor the Social Sciences for Windows, Version 15.0 (SPSSInc., Chicago, IL). Normal distribution of the quantita-tive variables was assessed by the Geary test. To establishthe association between physical activity as an ordinalvariable and the presence or not of high levels of Lp(a),Pearson’s x2 test was used. To find significant differencesbetween means of quantitative variables, grouped accord-ing to physical activity categories, one-way analysis of

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342 Bermudez et al

variance was used (With Tukeys post hoc test),considering significant values of P , 0.05. The resultswere expressed as absolute and relative frequencies andmean 6 standard deviation according to the case.

Determination of lipoprotein (a)

After centrifugation for 10 minutes at 4000 rpm, serumwas obtained from the blood sample taken from eachpatient. Lp(a) concentration was determined using theturbidimetric latex test method (Human Gesellschaftfur Biochemica und Diagnostica mbH, Wiesbaden,Germany).21 In this method, the sample inducesagglutination of latex particles coated with anti-Lp(a)antibodies. The agglutination is proportional to thelevels of Lp(a) and can be measured by turbidimetry.

Classification of physical activity levels

Categorization of physical activity was made accord-ing to the IPAQ Research Committee,22 classifying itinto three levels: 1) low—no activity is reported orsome activity is reported but not enough to meetcategories 2 or 3; 2) moderate—either of the followingthree criteria: a) 3 or more days of vigorous-intensityactivity of at least 20 minutes per day or b) 5 or moredays of moderate-intensity activity and/or walking ofat least 30 minutes per day or c) 5 or more days of anycombination of walking, moderate-intensity or vigor-ous-intensity activities achieving a minimum of at least600 MET-minutes/week; 2) high—any one of thefollowing two criteria: a) vigorous-intensity activityon at least 3 days and accumulating at least 1500 MET-minutes/week or b) 7 or more days of any combinationof walking, moderate- or vigorous-intensity activitiesaccumulating at least 3000 MET-minutes/week.

RESULTS

Study sample composition

A total of 1310 individuals from both sexes, 712 females(54.4%) and 598 males (45.6%), met all criterionnecessary to be included in this study. Mean age was39.42 6 15.82 years and body mass index arithmeticmean was 28.24 6 6.55 kg/m2.

Maracaibo is a multiethnic population The samplewas mainly constituted by persons of Venezuelan–mixed race (n = 980 [74.8%]), Hispanic white people(n = 244 [18.6%]), African–Venezuelan (n = 41 [3.1%]),Venezuelan Indians (Wayuu ethnicity) (n = 33 [2.5%]),Asian population (n = 4 [0.3%]), among others.

The socioeconomic status distribution according toGraffar scale (modified by Mendez-Castellano) wasstructured as follows: upper class: n = 24 (1.8%), high-middle class: n = 277 (21.1%), middle class: n = 461

(35.2%), low class: n = 468 (35.7%), and lower class orextreme poverty: n = 48 (3.7%).

Lipoprotein (a) behavior according to physicalactivity intensity

Lp(a) distribution in our population was near tonormal according to histogram, Q-Q graphics, andthe normality Gaerys test. Lp(a) concentration for thetotal population examined was 26.28 6 12.64 mg/dL(IC: 25.59–26.96). There were no significant differencesin Lp(a) levels between both sexes; females with26.54 6 12.56 mg/dL (IC: 25.63–27.44) versus maleswith 25.97 6 24.80 mg/dL (IC: 24.92–27.02).

According to the IPAQ analysis, 24.3% of the samplehad low physical activity (n = 318), 35.0% had mod-erate physical activity (n = 458), and 40.8% exhibitedhigh physical activity (n = 534). When comparing METscalculated by IPAQ for low (448.72 6 860.38; IC:353.79–543.64), moderate (1541.39 6 933.45; IC: 1455.67–1627.10), and high (8640.52 6 6733.34; IC: 8068.13–9212.92) physical activity levels, significant differenceswere found among all groups: low vs moderate (P =0.002); low vs high (P , 0.001) and finally, moderate vshigh (P , 0.001).

Individuals with high (30 mg/dL or greater) ornormal Lp(a) levels (less than 30 mg/dL) were groupedaccording to their physical activity intensity and thenclassified according to physical activity intensity(Fig. 1), showing a greater number of patients withnormal Lp(a) levels and high physical activity whencompared with Lp(a) levels in individuals with normaland low physical activity with a significant differenceas evidenced in Table 1. Moreover, the associationbetween the presence or not of high Lp(a) levelsaccording physical activity categories through Pear-son’s x

2 test was strong and statistically significant (x2

= 13.073, P = 0.001) indicating that those with a highlevel of physical activity do not show a high Lp(a) level.The mean Lp(a) plasma concentration for each physicalactivity level (low, moderate, and high) was 29.22 6

13.74, 26.27 6 12.91, and 24.53 6 11.35 mg/dL,respectively, evidencing significant differences whencomparing these values (P , 0.05; Fig. 2; Table 2).

DISCUSSION

It is widely accepted that Lp(a) concentration is geneti-cally regulated in 90%, at least in whites.23 Maybeapproximately 40% of this variability is the result ofquantitative polymorphisms in the internal sequence ofthe Apo (a) structural gene and other polymorphismsin the promoter site account for other 10% to 14%24

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Physical Activity and Lipoprotein(a) Levels 343

level variability. Environmental and other geneticfactors influence very little.25,26

Nonetheless, it has been proved that native sub-Saharian Africans have two- to threefold increasedLp(a) levels when compared with whites and Asians.27

In other words, Lp(a) varies according to the ethnicgroup, which is consistent with the fact that inheritanceis the main factor determining Lp(a) concentrations.

Over 34 isoforms of Lp(a) have been described,which depend on the number of Type 2 Kringle 4dominion copies that the apo(a) gene codifies locatedin chromosome 6.28 In whites, there is an inverseproportional correlation between Lp(a) concentrationsand the size of the apo(a) gene, reporting that 40% to70% of level variations are the result of the number ofKringle 4 dominions. On the other hand, individualswith African ancestry have lesser correlation withKringle copies only being responsible for 20% of theconcentration variations.12 Nevertheless, other studieshave reported interindividual variations of the apo(a)gene that are responsible for 91% and 70% of thevariation in the Lp(a) levels in whites and blacks,respectively.29,30 More investigation is needed withrepresentative samples of the ethnic groups to fullycomprehend the characteristics of the isoforms, thenumber of copies of the pentanucleotide TTTTA in thepromoter region, and the polymorphisms of a single

nucleotide to establish the complete influence of gencontrol in Lp(a) plasmatic levels.

On the other hand, ‘‘sedentary lifestyle’’ and ‘‘activelifestyle’’ definitions are equally complicated, becauseit is enduring to find common unifying criteria for itsevaluation and cardiovascular risk estimation. Eitherway, there are existing methods with great specificityand easy applicability that include all the necessaryelements (intensity, frequency, duration, and type ofphysical activity) to consider them reliable andaccurate in regard to physical activity evaluation.

Such is the case of the IPAQ created by the Group forConsensus of Physical Activity Measurements underthe direction of the World Health Organization with 25participating countries.31 IPAQ has important valida-tion and reproducibility studies such as that conductedby Craig et al32 in 12 countries. IPAQ constitutes one ofthe main references to the measurement of physicalactivity, being then known as the gold standard forvalidating other questionnaires, and has even served asprimer when developing other instruments based onits structure.33

There are fewer than 50 studies34–36 that haveconsidered the relation between Lp(a) concentrationand physical activity (Table 3). Above all these, therehave been some controversial results. Some possibleconditioning factors that disagree according to theliterature are: 1) size of the sample and its represent-ability; 2) differences in the studied population (gender,age group, ethnicity/race, comorbidities associated,lifestyle and its complicated definitions, and exclusioncriteria); 3) method for determining Lp(a) and itsisoforms; 4) method for determining physical activity;5) statistical analysis used; and 6) differences in theexperimental design (longitudinal or cross-sectionalstudies, type and duration of the physical activity).

Regarding the last item in the previous list,longitudinal interventionist studies have been doneusing short durations (less than 8 days) and those thatinclude longer periods. The former include acutephysical activity (short duration),37–39 some of themoriented to include or exclude Lp(a) as an acute phasereactant.40–42 The latter are looking to determine thepositive or negative influence of physical activity in theplasmatic levels of Lp(a).43–50

The advantage of the longitudinal studies is that theycan establish a direct measurement of the type ofphysical activity that influences directly on Lp(a)levels. Taking into account that short-duration exercise,in theory, can hardly influence Lp(a) concentrations,38–

42 because it does not provide enough time for any geneexpression change; therefore, there is not enough timeto affect Lp(a) levels. Long-duration studies wouldbe ideal to evaluate this situation; nonetheless, the

FIGURE 1. Frequencies distribution of individuals withhigh or normal lipoprotein (a) concentration according tophysical activity level.

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344 Bermudez et al

Table

1.

Ass

oci

ati

on

be

twe

en

lip

op

rote

in(a

)[L

p(a

)]le

ve

lsa

nd

ph

ysi

cal

act

ivit

yp

att

ern

s.

Hig

hL

p(a

)(3

0m

g/d

Lo

rg

rea

ter)

Ph

ysi

cal

act

ivit

y

Lo

wM

od

era

te

Me

nW

om

en

To

tal

Me

nW

om

en

To

tal

n%

n%

n%

n%

n%

n%

Ye

s5

93

9.3

67

39

.91

26

39

.66

93

48

43

2,9

15

33

3,4

No

91

60

.71

01

60

.11

92

60

.41

34

66

17

16

7,1

30

56

6,6

To

tal

15

01

00

16

81

00

31

81

00

20

31

00

25

51

00

45

81

00

x2

(Pv

alu

e)

4.1

20

(0.0

42

)5

.32

9(0

.02

1)

9.4

39

(0.0

02

)0

.26

7(0

.60

5)

(0.0

23

)(0

.87

9)

(0.2

11

)(0

.64

6)

Od

ds

rati

o(C

l)1

.3(1

.01

–1.7

7)

1.3

72

(1.0

5–1

.79

)1

.3(1

.1–.

15

)1

.06

4(0

.84

2–1

.34

)1

.01

6(0

.82

–1.2

5)

1.0

1(0

.8–1

.25

)x

2(P

va

lue

)1

3.0

73

(0.0

01

)

Hig

hL

p(a

)(3

0m

g/d

Lo

rg

rea

ter)

Ph

ysi

cal

act

ivit

y

Hig

h

Me

nW

om

en

To

tal

n%

n%

n%

Ye

s6

72

7,3

81

28

14

82

7,7

No

17

87

2,7

20

87

23

86

72

,3T

ota

l2

45

10

02

89

10

05

34

10

0x

2(P

va

lue

)5

.22

9(0

.02

2)

4,5

98

(0,0

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)9

,77

1(0

,00

2)

Od

ds

rati

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.77

8(0

.62

–0.9

7)

0,8

06

(0,6

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.7(0

,6–0

,9)

x2

(Pv

alu

e)

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Physical Activity and Lipoprotein(a) Levels 345

majority do not last over 3 months43,45,47 to evaluatea possible genetic regulation, and the very few that dolast over 3 months usually have a population samplethat is either too small or nonrepresentative.46,49,50

Cross-sectional studies can be divided into twogroups: one that compares the lifestyle of a certaingroup that has a vast physical activity (sportsmanship)versus sedentary individuals.51–54 Others take a ran-dom population, to which physical activity question-naires are applied to really get to know their lifestylesand categorize them into levels, evaluating Lp(a)concentrations.55–60

Our study shows an association between high Lp(a)concentrations (30 mg/dL or greater) and the threecategories for physical activity (x2 = 13.073; P = 0.001)with the main conclusion that people with high

physical activity do not show elevated concentrationsof Lp(a). When evaluating this finding, there was astrong association between high physical activity andLp(a) levels below 30 mg/dL (x2 = 9.771; P = 0.002), butthere is no association with moderate physical activity(x2 = 0.211; P = 0.646). In the same manner, those whodo not have a low physical activity level have Lp(a)levels below 30 mg/dL (x2 = 9.439; P = 0.002). Theserelations were maintained in the presence of high orlow Lp(a) concentrations at each physical activity levelaccording to gender (Table 1), which concurs withhaving found no difference between Lp(a) concen-trations in both genders.

Additionally, Figure 2 shows the significant differ-ences between Lp(a) levels from all the individuals forlow physical activity comparing it with those withmoderate (P = 0.004; IC: 0.80–5.09) and high (P , 0.001;IC: 2.60–6.76) physical activity, but not betweenmoderate and high (P = 0.076; IC: –0.13–3.60) physicalactivity.

As mentioned before, there are some discrepanciesconcerning the influence of physical activity on Lp(a)levels. One of the oldest studies reported a loweringeffect on Lp(a) with acute physical activity, meaning,8 days of daily cross- country skiing –12 to 25 km ina cold weather and dramatic dietary alterations.44

These conclusions contrast with other studies, whichhave found no evidence of this influence39–42; one inparticular was done by Durstine et al38 who argue thatin the cross country skiing study, plasmatic volumechange, cold exposure, and weight lost have to be takeninto account. It also shows the deficiency of plasmaticvolume determination in studies related to raisingLp(a) values after some exercises like that done byrunners, because the plasmatic volume can changeover 10% during the exercise and days after.

Table 2. Lipoprotein (a) [Lp(a)] concentration according to physical activity patterns and gender

Physical activity

Low Moderate

Men Women Both Men Women Both

Lp(a) 29.48 6 13.69 28.98 6 13.81 29.22 6 13.74 25.94 6 13.60 26.53 6 12.36 26.27 6 12.91Cl 27.27–31.69 26.88–31.09 27.70–30.73 24.05–27.82 25.01–28.06 25.08–27.45

Physical activity

High

Men Women Both

Lp(a) 23.84 6 11.77 25.12 6 10.98 24.53 6 11.35Cl 22.36–25.32 23.85–26.39 23.57–25.50

FIGURE 2. Lipoprotein (a) concentration according physicalactivity level.

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346 Bermudez et al

Set on to evaluate the influence of physical activityon Lp(a) levels, Ponjee et al49,50 subjected 36 sedentaryindividuals to a training regimen of three to four timesa week for 9 months, in which after 24 weeks, subjectsran a 15-km race and after 36 weeks a 21-km marathon.Their conclusions were that an exercise program thatincludes running marathons to longer distancesincreases Lp(a) concentrations. Contributing to thisdebate, Cardoso et al59 suggested that the elevation ofLp(a) in high-exercise athletes can represent a normalmetabolic response to small repetitive lesions in tissuesproduced by massive muscle movement in prolongedand frequent periods.

On the other hand, Austin et al37 evaluated patientswith Type 1 diabetes and showed an inverse relation-ship between Lp(a) and lipid profile with the use of thestatic bicycle with a standard ergonometer, pointingout that physical activity is a beneficial tool incontrolling these patients. Another study furtherconfirms positive influence of physical activity inpatients with Type 1 and Type 2 diabetes.48

Cross-sectional studies also have published contro-versial results. Comparing 57 endurance runners and62 control subjects showed no significant differences,54

which concurs with previous studies that have failed torecognize any difference using cardiorespiratory

Table 3. Relationship between lipoprotein (a) [Lp(a)] level and physical activity in human and experimental models.

Increased Lp(a) Concentration With Physical Activity

Sample (country) Assessment Findings Reference

219 subjects ODES,(Norway)

Study sedentary individuals thatwent through 1 year of physicalactivity and controlled diet

Increased Lp(a) concentrationrelated to exercise and habits

46

Decreased Lp(a) Concentration With Physical Activity

27 patients with diabetes;14 Type 1 and 13 Type 2,all under appropriateglycemic control (Spain)

Lp(a) determination before andafter a 3-month program ofphysical activity

Significant Lp(a) decrease insubjects with baseline greaterthan 30 mg/L (mean decreaseof 13%)

48

2464 subjects between9 and 24 years old(Finland)

Leisure–Physical ActivityAssessment questionnaire

Physical activity was associatedwith favorable Lp(a) values,and values greater than25 mg/dL were less frequentin individuals more physicallyactive

55

332 healthy men among20 and 60 years old;202 marathon runners;130 subjects selected byrandom (Spain)

Minnesota Leisure Time PhysicalActivity Questionnaire

Lp(a) concentration wassignificantly higher in subjectswith familiar history ofcoronary artery disease andphysical activity under300 kcal/day

52

No Changes in Lp(a) Concentration With Physical Activity

43 Wistar male rats Vigorous physical activity andaerobic added tohypercholesterolemic diet

No changes in Lp(a)concentration

45

28 white men between40 and 60 years old(Australia)

Lp(a) determination before andafter an intense–moderatetraining of 12 weeks

No changes in Lp(a)concentration

47

200 healthy men with amean age of18.8 6 0.11 years old,who are part ofUnited KingdomArmy (United Kingdom)

Lp(a) determination before andafter a 10-week MilitaryProgram characterized by anintense physical activity

Lp(a) does not behave as anacute phase reactant,observing any significantchanges in its concentrationafter the training

43

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Physical Activity and Lipoprotein(a) Levels 347

fitness.57,60 A study using a sample of 1600 Irish peoplesuggested that the increment of physical activityproduced small changes in Lp(a) concentrations.56

It is proper to emphasize the lack of definition ofsedentary lifestyle that is used in some studies.Meanwhile, other studies have used questionnairesand/or classifications for physical activity that weremade by the investigating team and not approvedtools. There are existing limitations in these kinds ofquestionnaires; one of the frequent fouls found is notmeasuring the leisure time and daily work56 that couldeven place a person considered as sedentary in a highercategory of physical activity.

On the contrary, our results show a clear relationshipbetween physical activity level and Lp(a) concentra-tion. A previous study showed similar results, Taimelaet al55 did a multicentric study in 2464 children,adolescents, and young adults between 9 and 24 yearsof age evaluating the risk factors for cardiovasculardisease. They concluded that physically active indi-viduals seldom had Lp(a) levels above 25 mg/dLwithout any relation with age, gender, or othercardiovascular risk factor.

Our study overcomes the usual obstacles to extrap-olate results, because of its size and representativepopulation of Maracaibo. The results concur for bothgenders, application of measurement questionnaire ofphysical activity—internationally validated—and, us-ing appropriate statistical analysis, bearing significantresults.

Nevertheless, this research presents some interestinglimitations. The cross-sectional design of this workcannot corroborate if a determined exercise done ina specific way for a given amount of time is capable ofreducing Lp(a) concentrations. Either way, IPAQevaluated daily activities (exercise at work, trans-portation method, leisure time, domestic life, andgardening), which sheds some light to the type oflifestyle, beyond the programmed activities scheduledfor a brief period of time. It is also recognized thatisoforms of Lp(a) nor its different polymorphisms wereundetermined, being unable, hypothetically, to relatedto the level of physical activity with the diminishmentof certain specific isoforms and not others. Likewise,the lowering effect of physical activity on Lp(a) levelscan influence only the concentration of a specificpolymorphism.

CONCLUSIONS

Our study shows that a lifestyle characterized by highphysical activity is associated with Lp(a) concentra-tions below 30 mg/dL in an urban Venezuelan–mixed

population. This relationship is reinforced by thefinding that significantly lower Lp(a) concentrationsare found in individuals with moderate to highphysical activity compared with those with lowphysical activity.

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