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The inflammatory biomarker YKL-40 decreases stepwise after exercise stress test

Dam Mygind, Naja; Axelsson, Anna; Ruwald, Martin H.; Dalsgaard, Morten; Steffensen, Rolf; Iversen, Kasper; Johansen, Julia S.; Kastrup, Jens

Cardiovascular Endocrinology: March 2016 - Volume 5 - Issue 1 - p 21–27
doi: 10.1097/XCE.0000000000000073
Original articles

Background: Serum YKL-40 is an inflammatory biomarker associated with disease activity and mortality in diseases characterized by inflammation such as coronary artery disease (CAD). Exercise has a positive effect on CAD, possibly mediated by a decreased inflammatory activity. This study aimed to compare serial measurements of serum YKL-40 before and after exercise in patients with stable CAD versus controls.

Materials and methods: Eleven patients with stable CAD verified by coronary angiography (>70% stenosis) and 11 patients with a computer tomography angiography with no stenosis or calcification (calcium score=0) (controls) performed a standard clinical maximal exercise test. Serum YKL-40 was measured before exercise, immediately after exercise, and every hour for 6 h.

Results: Cardiovascular risk factors were more prevalent among the CAD patients compared with the controls. CAD patients had higher serum concentration of YKL-40 at baseline compared with controls, median (interquartile range) 94 (52–151) versus 57 (45–79) μg/l. Serum YKL-40 decreased stepwise after exercise, with a median decrease of 16 (13–39) μg/l for the CAD patients and 13 (10–22) μg/l for the controls from baseline to the lowest value. Thereafter, values increased again toward baseline level. Time after exercise was a significant factor for decrease in serum YKL-40 (P<0.0001), but no difference in YKL-40 decrease over time could be demonstrated between the groups (P=0.12).

Conclusion: Serum YKL-40 is elevated in patients with documented CAD compared with controls, and it decreases stepwise after exercise in both groups, indicating an anti-inflammatory effect of exercise independent of the presence of coronary atherosclerosis.

aDepartment of Cardiology, Copenhagen University Hospital Rigshospitalet

bDepartment of Cardiology, Copenhagen University Hospital Hillerød

Departments of cCardiology

dMedicine and Oncology, Copenhagen University Hospital Herlev

eDepartment of Cardiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark

Correspondence to Naja Dam Mygind, MD, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark Tel: +45 3545 1783; fax: +45 3545 2705; e-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way nor used commercially.

Received December 1, 2015

Accepted January 6, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
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