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(Circulation. 2000;102:e168.)
© 2000 American Heart Association, Inc.

Correspondence

Can Aerobic Exercise Training Be Hazardous to Human Vessels?

Pierre Abraham, MD, PhD

Jean-Louis Saumet, MD, PhD; Benedicte Desvaux, PhD

Bérengère Fromy, PhD

Laboratory of Vascular Investigations, University Hospital, Angers, France

To the Editor:

Exercise training is widely used as an efficient method of rehabilitation from or prevention of cardiovascular diseases. Improvement in endothelium-dependent vasodilation could be one of the underlying mechanisms of this effect, as was recently suggested by Higashi et al.¹ Because the intensity and duration of training are directly related to performance improvement, it could be expected that highly trained athletes would be at a particularly low risk of vascular disease. Therefore, the recent description of endofibrosis (an original arterial disease affecting mainly highly trained cyclists) is puzzling.² Endofibrosis occurs principally in the external iliac artery and is characterized by the progressive thickening of the endothelial arterial wall by fibrosis. Mechanical trauma, jet lesions, and local shear stress mechanisms have been suggested as causes, but they do not explain the preferential localization of the lesions. The affected athletes generally have no known cardiovascular risk factors. Further, histological examination rarely reveals lipid inclusions in the lesions, even in cases of extremely delayed diagnosis, suggesting that these lesions are not early atherosclerotic lesions. Finally, the relationship between endofibrosis and either metabolic mutations (eg, homocystinuria), or illegal drug use (eg, erythropoietin or growth hormone) is unclear. Because endofibrosis seems to be related to the level and duration of training (the disease is rare in athletes before they have cycled a total of 120 000 to 150 000 km), it is interesting to note that a recent study showed decreased endothelium-dependent vasodilation in humans after intense training,³ in contrast to the increase . . . [Full Text of this Article]

Yukihito Higashi, MD, PhD

Shota Sasaki, MD

Satoshi Kurisu, MD

Atsunori Yoshimizu, MD

Nobuo Sasaki, MD

Hideo Matsuura, MD, PhD

Goro Kajiyama, MD, PhD

First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan

Tetsuya Oshima, MD, PhD

Department of Clinical Laboratory Medicine, Hiroshima University School of Medicine, Hiroshima, Japan