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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Change in Cardiometabolic Health Following Participation in Cardiac Rehabilitation for Coronary Heart Disease: Effect
Joshua Garfein1, Elizabeth A Gnatiuk1,2, Eric J Brandt1,3
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Insights
Patients with metabolic syndrome (MetS) experienced significant improvements in cardiometabolic risk factors after cardiac rehabilitation (CR). These benefits, including weight loss and reduced triglycerides, were comparable or greater than those without MetS.
Area of Science:
- Cardiology
- Metabolic Health
- Rehabilitation Medicine
Background:
- Coronary heart disease (CHD) patients often have co-existing metabolic syndrome (MetS).
- Cardiac rehabilitation (CR) is a key intervention for CHD patients.
- The impact of CR on cardiometabolic risk factors in patients with MetS is not fully elucidated.
Purpose of the Study:
- To assess changes in cardiometabolic risk factors post-CR in CHD patients.
- To compare the magnitude of CR benefits between patients with and without MetS.
Main Methods:
- Observational cohort study of 1984 CHD patients undergoing CR.
- Collected baseline and post-CR data on cardiometabolic biomarkers.
- Used statistical analyses, including difference-in-differences regression, to compare outcomes by MetS status.
Main Results:
- Patients with MetS showed greater reductions in weight, BMI, and waist circumference compared to those without MetS.
- MetS group experienced significant decreases in triglycerides and fasting glucose.
- No significant differences in HDL-C or LDL-C changes were observed between groups.
Conclusions:
- Patients with MetS derive comparable or greater benefits from CR than those without MetS.
- CR effectively improves key components of metabolic syndrome in CHD patients.
Objective:
To investigate changes in cardiometabolic risk factors after completion of cardiac rehabilitation (CR) for coronary heart disease (CHD) and ascertain whether the magnitude of improvement in cardiometabolic health differs between those with and without metabolic syndrome (MetS).
Methods:
In this observational cohort study, data were analyzed from 1984 patients enrolled in CR at the University of Michigan between 2011-01-01 and 2020-02-29 for the indication of CHD. Patient characteristics were collected from standardized health questionnaires and during CR intake evaluations. Cardiometabolic biomarkers were recorded from baseline laboratory data and re-examined upon completion of CR. Differences in baseline patient characteristics by MetS status were compared using chi-square tests. Wilcoxon rank-sum tests were used to compare baseline differences, and signed-rank tests were used to evaluate the change in variables between baseline and completion of CR. The difference of change by MetS status was assessed using difference-in-differences regression models.
Results:
Of the 1984 patients, 1070 (53.9%) met the criteria for MetS at baseline, of which 770 were male (72.0%). Those with MetS lost 1.43 pounds more (95% CI: 0.56, 2.31, P = 0.001), experienced a 0.21 larger drop in body mass index (95% CI: 0.03, 0.37, P = 0.02), and had a 0.31 greater reduction in waist circumference (95% CI: 0.08, 0.54, P = 0.008). Difference-in-differences regression models revealed those with MetS experienced a greater reduction in triglycerides and fasting glucose, with a difference of change of -8.70 for triglycerides (95% CI: -15.04, -2.37, P = 0.007) and -5.48 for glucose (95% CI: -10.44, -0.53, P = 0.03). There was no significant difference in the change in HDL-C or LDL-C for MetS status.
Conclusion:
Compared to those without MetS, patients with MetS experienced a comparable or greater benefit from CR, particularly with respect to improvements in MetS components.
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