Physical activity in carotid atherosclerotic patients blunts monocyte pro-inflammatory processes: a randomised controlled trial

BACKGROUND AND AIMS: Up to 25 % of ischemic strokes are the consequence of a ruptured vulnerable carotid atherosclerotic plaque. Circulating pro-inflammatory classical and intermediate monocytes are known predictors of ischemic events and cardiovascular death. Interestingly, chronic physical activity can decrease inflammation, and is thereby associated with a reduction in pro-inflammatory monocytes. METHODS: In a randomized, controlled and monocentric trial, we recruited 56 patients (71 ± 8 years old) with asymptomatic carotid stenosis of ≥50 % who were ineligible for carotid endarterectomy. Blood analyses were completed to assess the phenotype of monocytes, as well as a multiplex assay and colorimetric assay for cytokines concentration and redox status, respectively. RESULTS: Classical monocyte count was increased in the control arm, while it remained stable in response to the physical activity intervention (-5215 ± 2307, [95 %CI -9878 to -551], p = 0.03). Moreover, the expression of most of pro-inflammatory cytokines was down-regulated in response to the physical activity intervention, while it was increased in the control arm. CONCLUSIONS: The stabilization of classical monocytes and down-regulation of the expression of pro-inflammatory cytokines in response to the physical activity intervention suggest that chronic physical activity alleviate the pro-inflammatory state, and might thereby reduce carotid plaque vulnerability and the subsequent risk of ischemic events. These results highlight that home-based physical activity intervention is an efficient clinical care that induce biological changes in carotid atherosclerotic patients.