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Gender alters the high-density lipoprotein cholesterol response to cardiac rehabilitation
Patrick D Savage1, Martin Brochu, Philip A Ades
1Division of Cardiology, University of Vermont College of Medicine Burlington, Vermont 05401, USA.
Insights
Cardiac rehabilitation exercise significantly improves high-density lipoprotein cholesterol (HDL-C) more in women than men. Women saw HDL-C increases regardless of baseline levels, while men only improved if they started with low HDL-C.
Area of Science:
- Cardiology
- Exercise Physiology
- Lipid Metabolism
Background:
- Reduced high-density lipoprotein cholesterol (HDL-C) is a key risk factor for coronary heart disease (CHD).
- Cardiac rehabilitation (CR) programs aim to improve cardiovascular health and manage risk factors in patients with CHD.
Purpose of the Study:
- To evaluate the impact of CR exercise training on HDL-C and lipid subfractions.
- To investigate the influence of gender and baseline HDL-C levels on these changes.
Main Methods:
- 340 CHD patients completed 36 exercise sessions over 12 weeks in an outpatient CR program.
- Patients were stratified by baseline HDL-C levels (high or low) and gender, following NCEP ATP III guidelines.
Main Results:
- Women showed a significantly greater overall improvement in HDL-C (14%) compared to men (7.1%).
- Women with high baseline HDL-C increased levels by 8.4%, while men showed no significant change (0.9%).
- Women with low baseline HDL-C also had a greater improvement (15.3%) than men (11.5%).
Conclusions:
- Women experience superior HDL-C improvements from CR exercise compared to men, irrespective of fitness or body composition changes.
- Gender significantly influences HDL-C response to CR; women benefit universally, while men's improvement is contingent on baseline HDL-C.
- Clinicians should consider gender-specific responses when setting risk factor goals and therapeutic strategies for CHD patients undergoing CR.
Purpose:
A reduced level of high-density lipoprotein cholesterol (HDL-C) is a powerful independent risk factor for the development and progression of coronary heart disease. This study assessed the effects of cardiac rehabilitation exercise training on HDL-C and other lipid subfractions, giving close attention to the role of gender and baseline values.
Methods:
The study population consisted of 340 patients with coronary heart disease who enrolled in outpatient cardiac rehabilitation and completed 36 sessions of exercise over a 12-week period. With the National Cholesterol Education Panel ATP III guidelines used to create categories of HDL-C, patients were stratified at baseline into four subgroups: (1) males with high HDL-C, (2) males with low HDL-C, (3) women with high HDL-C, and (4) women with low HDL-C.
Results:
Overall, women experienced a significantly greater improvement in HDL-C after exercise training than men (14% vs 7.1%; P <.0001). Among the patients with a high HDL-C at baseline, the women increased HDL-C by 8.4%, whereas there was no change (0.9%) in the men (P <.001 between groups). Additionally, the women with low HDL-C experienced a significantly greater improvement than the men (15.3% vs 11.5%, P <.03).
Conclusions:
The study results demonstrate that women experience a greater improvement in HDL-C with cardiac rehabilitation than men despite similar changes in fitness and body composition. Women, regardless of baseline HDL-C, demonstrated improvements in HDL-C, whereas only men with low HDL-C experienced an increase in HDL-C. These results describe a differing impact of cardiac rehabilitation on changes in HDL-C based on gender. Clinicians should consider the impact of gender when assessing an individual's risk factor goals and therapeutic options.
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