Lipid profile changes through nurse-led cardiac rehabilitation: evidence from a systematic review and meta-analysis

Cardiovascular diseases (CVDs) continue to be the leading cause of death worldwide, with dyslipidemia as one of their main risk factors. Nurse-led cardiac rehabilitation (NLCR) has been shown to improve the quality of life of cardiac patients. We aim to measure its effect on lipid levels.

We conducted a systematic review and meta-analysis of clinical trials comparing NLCR with usual care. Major electronic databases and grey literature sources were searched through July 31, 2025. Eligible studies reported at least one lipid outcome, including triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Risk of bias was assessed using RoB 2.0 for randomized controlled trials (RCTs) and ROBINS-I for non-RCTs. Random-effects models were used to calculate pooled standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs).

Ten studies were included in the meta-analysis. NLCR was associated with a significant reduction in TG levels (SMD = - 0.19; 95% CI: -0.36 to - 0.02), corresponding to an absolute reduction of 8.38 mg/dL (MD = - 8.38; 95% CI: -13.82 to - 2.94). Changes in TC (MD = - 6.03 mg/dL; 95% CI: -14.57 to 2.51), LDL-C (MD = - 4.78 mg/dL; 95% CI: -9.89 to 0.33), and HDL-C (MD = 1.90 mg/dL; 95% CI: -2.30 to 6.10) did not reach statistical significance in the overall analysis. Subgroup analyses demonstrated a significant TG reduction among RCTs (MD = - 9.25 mg/dL; 95% CI: -14.84 to - 3.65). According to follow-up duration, studies with follow-up durations of ≤ 3 months showed a significant reduction in TC levels (MD = - 9.81 mg/dL; 95% CI: -14.13 to - 5.49), whereas studies with follow-up durations of > 3 months demonstrated a significant reduction in TG levels (MD = - 8.02 mg/dL; 95% CI: -13.95 to - 2.09). Meta-regression analyses identified study design as a significant predictor of TG and LDL changes.

NLCR was associated with a significant reduction in TG levels among patients with CVD, while changes in TC, LDL-C, and HDL-C were not statistically significant. Subgroup and meta-regression analyses suggested that study design and follow-up duration may influence lipid outcomes. Further high-quality RCTs with longer follow-up are needed to confirm these findings and evaluate their long-term clinical implications.