The Impact of Exercise Training on Circulating S-Klotho in Lean and Obese Coronary Artery Disease Patients - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Evgeny Radzishevsky Department of Cardiology, Bnei –Zion Medical Center, Haifa, Israel MO Saghiv Department of Exercise Physiology, Harold C. Miller Center, University of Mary, Bismarck, USA Ehud Goldhammer Department of Cardiology, Bnei –Zion Medical Center, Haifa, Israel Ch. Sherve Department of Exercise Physiology, Harold C. Miller Center, University of Mary, Bismarck, USA Irit Maor Department of Cardiology, Bnei –Zion Medical Center, Haifa, Israel Uri Rosenschein Department of Cardiology, Bnei –Zion Medical Center, Haifa, Israel

Background: Klotho is a membrane-based circulating protein that regulate cell metabolism, and modulate activity of Fibroblast Growth Factors. Higher plasma circulating Klotho levels associated with reduced cardiovascular risk. Recent studies have identified klotho as a target gene for peroxisome proliferator-activated receptor-γ, a master regulator of adipocyte differentiation. Aerobic exercise reduces the risk of cardiovascular events in patients with coronary artery disease (CAD), thus, S-Klotho serum levels were assessed in lean and obese patients in order to find out whether exercise can modulate its activity.

Purpose: to assess the impact of 12 weeks exercise training program on S-Klotho in obese vs lean CAD patients, include possible correlation between S-Klotho and diabetes.

Methods: S-Klotho was assessed pre and post 12 weeks supervised aerobic exercise program (45 min/4-5 sessions/week) in 2 groups, Gr. A = 27 CAD patients with BMI ≤ 29, age 59.7 years ± 2.2 sd, and Gr. B = 13 CAD patients with BMI ≥ 30, age 63 years ± 2.4sd. All patients had a recent (< 45 days) cardiovascular event or intervention. Assessment was done prior to exercise program and at the end of 12 weeks intervention. Serum S-Klotho levels were analyzed using an α-klotho enzyme linked immunosorbant assay kit (IBL, Immuno-Biological Laboratories Co., Japan), Germany.

Results: No difference (p= 0.21) was found at baseline for S-Klotho levels between the two groups, 730.49pg/ml +/- 201.20 sd and 715.33pg/ml +/- 209.11sd respectively, while a difference was found following exercise intervention, 843.27 pg/ml +/- 210.56 sd in the obese patients group compared to 767.51pg/ml +/- 167.46 sd in lean patients group, p = 0.037. S-Klotho had an inverse correlation with diabetes, at baseline and following exercise program.

Conclusions: Aerobic exercise may modulate S-Klotho activity, among obese patients in particular. If it contributes to the "obesity paradox" it should be further investigated.