Hunting to prevent aortic stenosis.

The advantages of exercise training in patients with atherosclerotic coronary artery disease are numerous and include the modification of traditional risk factors, improvement in myocardial and peripheral perfusion, enhancement of exercise tolerance, and reduction of cardiovascular morbidity and mortality.1 These salutary effects are thought to result from improvements in endothelial function and vascular inflammation. Although the precise mechanisms are not entirely clear, augmentation of nitric oxide bioavailability (by increasing expression and activity of endothelial nitric oxide synthase and reducing nitric oxide degradation), reduction of endothelial adhesiveness (by reducing expression of cellular adhesion molecules), enhancement of endothelial regenerative capacity (by stimulating endothelial progenitor cells), and reduction of vascular inflammation (by reducing proinflammatory cytokines and oxidative stress and increasing antiinflammatory cytokines) by exercise-induced increases in blood flow and shear stress are responsible in large part for the beneficial effects of exercise on the pathogenesis and progression of atherosclerosis.1