Differential Improvements in Lipid Profiles and Framingham Recurrent Risk Score in Patients With and Without Diabetes Mellitus Undergoing Long-Term Cardiac Rehabilitation

• Published in: Archives of physical medicine and rehabilitation Vol. 92; no. 9; pp. 1382 - 1387
• Main Authors: Carroll, Sean, PhD, Tsakirides, Costas, MSc, Hobkirk, James, BSc, Moxon, James W.A., MBChB, Moxon, James W.D., MBBS, DipSportMed, Dudfield, Michael, MSc, Ingle, Lee, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier
• Subjects: Aged; Biological and medical sciences; Body Mass Index; Body Weights and Measures; Cardiac rehabilitation; Cardiometabolic risk; Cardiorespiratory fitness; Coronary Disease - complications; Coronary Disease - rehabilitation; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diseases of the osteoarticular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Exercise Therapy - methods; Exercise Tolerance; Exercise training; Female; High-density lipoprotein cholesterol; Humans; Lipids - blood; Low-density lipoprotein cholesterol; Male; Medical sciences; Middle Aged; Miscellaneous; Patient Education as Topic; Physical Fitness; Physical Medicine and Rehabilitation; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Retrospective Studies; Risk Assessment; Type 2 diabetes; Type 2 diabetes; ETT; LDL-C; FRS; RPE; Cardiometabolic risk; total cholesterol; Low-density lipoprotein cholesterol; HDL-C; rating of perceived exertion; electrocardiogram; Cardiac rehabilitation; EUROASPIRE; SCRIP; Scandinavian Simvastatin Survival Study; DANSUK; Exercise training; 4S; BMI; DANish StUdy of impaired glucose metabolism in the settings of cardiac rehabilitation; exercise tolerance test; body mass index; Framingham risk score; ECG; European Action on Secondary Prevention through Intervention to Reduce Events; High-density lipoprotein cholesterol; CR; TC; Stanford Coronary Risk Intervention Project; CRF; Cardiorespiratory fitness; coronary heart disease; Rehabilitation; CHD; Endocrinopathy; Heart; Physical exercise; Human; Relapse; Metabolic diseases; Lipids; Lipoprotein; Density; Long term; Cholesterol; Reeducation; Orthopedics; Risk factor
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2011.04.013

Abstract Carroll S, Tsakirides C, Hobkirk J, Moxon JWA, Moxon JWD, Dudfield M, Ingle L. Differential improvements in lipid profiles and Framingham recurrent risk score in patients with and without diabetes mellitus undergoing long-term cardiac rehabilitation. Objective To determine whether lipid profiles and recurrent coronary heart disease (CHD) risk could be modified in patients with and without diabetes mellitus undergoing long-term cardiac rehabilitation (CR). Design Retrospective analysis of patient case records. Setting Community-based phase 4 CR program. Participants Patients without diabetes (n=154; 89% men; mean ± SD age, 59.6±8.5y; body mass index [BMI], 27.0±3.5kg/m2 ) and patients with diabetes (n=20; 81% men; mean age, 63.0±8.7y; BMI, 28.7±3.3kg/m2 ) who completed 15 months of CR. Interventions Exercise testing and training, risk profiling, and risk-factor education. Main Outcome Measures Cardiometabolic risk factors and 2- to 4-year Framingham recurrent CHD risk scores were assessed. Results At follow up, a significant main effect for time was evident for decreased body mass and waist circumference and improved low-density lipoprotein cholesterol (LDL-C) level and submaximal cardiorespiratory fitness (all P <.05), showing the benefits of CR in both groups. However, a significant group-by-time interaction effect was evident for high-density lipoprotein cholesterol (HDL-C) level and total cholesterol (TC)/HDL-C ratio (both P <.05). TC/HDL-C ratio improved (5.0±1.5 to 4.4±1.3) in patients without diabetes, but showed no improvement in patients with diabetes (4.8±1.6 v 4.9±1.6). Conclusions We showed that numerous anthropometric, submaximal fitness, and cardiometabolic risk variables (especially LDL-C level) improved significantly after long-term CR. However, some aspects of cardiometabolic risk (measures incorporating TC and HDL-C) improved significantly in only the nondiabetic group.