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 ± 3.5 kg/m²) and patients with diabetes (n=20; 81% men; mean age, 63.0 ± 8.7y; BMI, 28.7 ± 3.3 kg/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.