Abstract 4119635: The Effect of Exercise Training on Apolipoproteins: A Trial Sequence Meta-Analysis.

Background: The role of lipoprotein sub-units in the development of CVD not as well understood as for the standard lipid profile. We conducted a systematic review and meta-analysis of the effect of Exercise training (ExTr) effect on common lipid sub-units. Methods: We conducted a systematic search for randomized, controlled trials of ExTr versus sedentary controls that reported lipid sub-units Apo AI, Apo AII, Apo B, HDL-2, HDL-3 and Lp(a) up until January 31, 2024. Results: We included 24 included studies with 27 intervention groups, with a total of 1,429 participants, 775 ExTr and 654 control. We found significant favourable anti-atherogenic changes in Apo A1; MD 5.96 mg/dL 95% CI (3.63, 8.30); Apo B; MD -0.11 mg/dL (-0.19, -0.04); HDL-2; MD 1.28 mg/dL 95% CI (0.28, 2.28). Our TSA analysis showed that futility was achieved for Apo A1, but not for Apo B and HDL-2. The minimal clinically important differences (MCID) for Apo A1, Apo B and HDL-2 were 0.76 mg/dL, 0.02 mg/dL and 0.26 mg/DL respectively, meaning ExTr is capable of adequately achieving clinical significance for these 3 outcomes. Analyses of Apo A2, Lp(a)and HDL-3 were not significant and these TSA analyses failed to show futility. Conclusion: ExTr produces significant improvements in ApoA1, Apo B and HDL-2, with the MCID achieved and evidence of futility reached for all three of these outcomes. The effect of ExTr on Apo A2, Lp(a)and HDL-3 is unclear as futility has not been reached. ExTr changes observed in Apo AI are similar in size to those from statin trials that were associated with an 11% reduction in CV events.