Robust arm and leg muscle adaptation to training despite ACE inhibition: a randomized placebo-controlled trial.

PURPOSE: Angiotensin-converting enzyme (ACE) inhibitor treatment is widely applied, but the fact that plasma ACE activity is a potential determinant of training-induced local muscular adaptability is often neglected. Thus, we investigated the hypothesis that ACE inhibition modulates the response to systematic aerobic exercise training on leg and arm muscular adaptations. METHODS: Healthy, untrained, middle-aged participants (40 ± 7 yrs) completed a randomized, double-blinded, placebo-controlled trial. Participants were randomized to placebo (PLA: CaCO3) or ACE inhibitor (ACEi: enalapril) for 8 weeks and completed a supervised, high-intensity exercise training program. Muscular characteristics in the leg and arm were extensively evaluated pre and post-intervention. RESULTS: Forty-eight participants (nACEi = 23, nPLA = 25) completed the trial. Exercise training compliance was above 99%. After training, citrate synthase, 3-hydroxyacyl-CoA dehydrogenase and phosphofructokinase maximal activity were increased in m. vastus lateralis in both groups (all P < 0.05) without statistical differences between them (all time × treatment P > 0.05). In m. deltoideus, citrate synthase maximal activity was upregulated to a greater extent (time × treatment P < 0.05) in PLA (51 [33;69] %) than in ACEi (28 [13;43] %), but the change in 3-hydroxyacyl-CoA dehydrogenase and phosphofructokinase maximal activity was similar between groups. Finally, the training-induced changes in the platelet endothelial cell adhesion molecule-1 protein abundance, a marker of capillary density, were similar in both groups in m. vastus lateralis and m. deltoideus. CONCLUSION: Eight weeks of high-intensity whole-body exercise training improves markers of skeletal muscle mitochondrial oxidative capacity, glycolytic capacity and angiogenesis, with no overall effect of pharmacological ACE inhibition in healthy adults.

[Effect of treatment with levothyroxine in the lipid profile of the patients with subclinical hypothyroidism]. / Influencia del tratamiento con levotiroxina en el perfil lipídico de los pacientes con hipotiroidismo subclínico.

OBJECTIVE: Controversy surrounds the issue of whether levothyroxine treatment improves lipid profile in patients with subclinical hypothyroidism (SHT). The objective was to detect substantial differences -> or = 20% in total cholesterol (TC) and > or = 15 mg/dl in low-density lipoprotein cholesterol (LDL-c)- in the lipid profiles of patients with subclinical hypothyroidism (SHT) after initiating levothyroxine replacement therapy (T4). PATIENTS AND METHOD: Observational retrospective cohort study with paired data. LOCATION: Primary care center in Manresa (Barcelona). PARTICIPANTS: 100 patients with SHT treated with levothyroxine. MAIN MEASURES: Demographic and clinical variables from the clinical history, as well as temporal data -SHT diagnosis, beginning of T4 treatment and thyroid-stimulating hormone (TSH) normalization, and the quantity of T4 administered to treat SHT-were gathered. Data for TSH, lipid profile and body mass index were recorded at specific moments (beginning of treatment, after 6-18 months on T4, at the euthyroidism stage, and the last value registered in the previous 12 months). RESULTS: The mean age was 61+/-15 [95% confidence interval (CI), 46-76] years and 95% of the patients were women. Obesity was found in 40%, high blood pressure in 39%, dyslipidemia in 37%, diabetes mellitus in 10%, smoking in 7%, and cardiovascular disease in 6% of the patients. No significant differences were detected in TC or in LDL-c after treatment with levothyroxine. Nonsignificant reductions were found in TC (-4 mg/dl; p=0.77) and LDL-c (-10 mg/dl; p=0.31) when euthyroidism was achieved, as well as in TC (-10mg/dl; p=0.58) after 5+/-3 years of treatment. CONCLUSIONS: Levothyroxine treatment in patients with SHT does not lead to substantial reductions in TC or LDL-c, independently of TSH concentrations prior to treatment.

Influencia del tratamiento con levotiroxina en el perfil lipídico de los pacientes con hipotiroidismo subclínico / Effect of the treatment with levothyroxine in the lipid profile of the patients with subclinical hypothyroidism

Objetivo: existe la controversia de si el tratamiento con levotiroxina (T4) mejora el perfil lipídico de los pacientes con hipotiroidismo subclínico (HTS). el objetivo del estudio es detectar diferencias relevantes (≥ 20% en colesterol total [CT] y ≥ 15 mg/dl en colesterol de las lipoproteínas de baja densidad [cLDL]) en el perfil lipídico de los pacientes con hipotiroidismo subclínico después de iniciar tratamiento sustitutivo con levotiroxina. Pacientes y método: estudio observacional de cohortes históricas con datos apareados. Localización: Centro de atención Primaria de Manresa (Barcelona). Participantes: 100 pacientes con hipotiroidismo subclínico tratados con levotiroxina. Medidas principales: variables demográficas y clínicas procedentes de la historia clínica, así como datos temporales (de diagnóstico de HTS, de inicio de T4 y de normalización de la tirotropina [TSH]) y cantidad de T4 administrada para tratar el HTS). Para TSH, perfil lipídico e índice de masa corporal (IMC), se recogió el valor en determinados momentos evolutivos (en el momento de iniciar el tratamiento, a los 6-18 meses de tratamiento con T4, en el momento de eutiroidismo y el último valor registrado en los últimos 12 meses). Resultados: La media de edad fue 61 ± 15 (intervalo de confianza [IC] del 95%, 46-76) años. el 95% eran mujeres. el 40% de los pacientes presentaban obesidad; el 39%, hipertensión arterial; el 37%, dislipemina; el 10%, diabetes mellitus; el 7%, tabaquismo y el 6%, enfermedad cardiovascular. No se detectaron diferencias significativas en el CT ni en el cLDL con el tratamiento con levotiroxina. Se observaron disminuciones no significativas en: CT, ¿4 mg/dl (p = 0,77), y cLDL, ¿10 mg/dl (p = 0,31) en el momento de eutiroidismo y CT, ¿10 mg/dl (p = 0,58) después de 5 ± 3 años de tratamiento(AU)

Conclusiones: el tratamiento con levotiroxina en pacientes con HTS no se traduce en disminuciones relevantes de CT, independientemente del valor de TSH previo al tratamiento. Tampoco se traduce en disminuciones relevantes de cLDL (AU)

Objective: Controversy surrounds the issue of whether levothyroxine treatment improves lipid profile in patients with subclinical hypothyroidism (SHT). The objective was to detect substantial differences ¿≥ 20% in total cholesterol (TC) and ≥ 15 mg/dl in low-density lipoprotein cholesterol (LDL-c)¿ in the lipid profiles of patients with subclinical hypothyroidism (SHT) after initiating levothyroxine replacement therapy (T4). Patients and method: Observational retrospective cohort study with paired data. Location: Primary care center in Manresa (Barcelona). Participants: 100 patients with SHT treated with levothyroxine. Main measures: Demographic and clinical variables from the clinical history, as well as temporal data ¿SHT diagnosis, beginning of T4 treatment and thyroid-stimulating hormone (TSH) normalization, and the quantity of T4 administered to treat SHT¿ were gathered. Data for TSH, lipid profile and body mass index were recorded at specific moments (beginning of treatment, after 6-18 months on T4, at the euthyroidism stage, and the last value registered in the previous 12 months). Results: The mean age was 61 ± 15 [95% confidence interval (CI), 46-76] years and 95% of the patients were women. Obesity was found in 40%, high blood pressure in 39%, dyslipidemia in 37%, diabetes mellitus in 10%, smoking in 7%, and cardiovascular disease in 6% of the patients. No significant differences were detected inTC or in LDL-c after treatment with levothyroxine. Nonsignificant reductions were found inTC (¿4 mg/dl; p = 0.77) and LDL-c (¿10 mg/dl; p = 0.31) when euthyroidism was achieved, as well as inTC (¿10 mg/dl; p = 0.58) after 5 ± 3 years of treatment. Conclusions: Levothyroxine treatment in patients with SHT does not lead to substantial reductions in TC or LDL-c, independently of TSH concentrations prior to treatment (AU)