Abstract 17518: Good Attendance to Cardiac Rehabilitation is Associated with Achievement of Low C-Reactive Protein Levels in Patients after Acute Myocardial Infarction

Abstract

Backgrounds: Cardiac rehabilitation with exercise training (CR/ET) has been reported to be associated with reduction in C-Reactive Protein (CRP). In patients with acute coronary syndrome receiving statin therapy, achievement of CRP levels below 2mg/L is known to be important for long-term event-free survival. However, the determinants of achieving low CRP after CR/ET are not fully understood. Methods: To address this issue, we studied 490 consecutive acute myocardial infarction (AMI) patients who participated in our CR/ET program and underwent measurements for serum CRP at the beginning and the end of the 3-month CR program. Patients with abnormally high CRP (>= 20mg/L at baseline, >=10mg/L at 3 months) or on hemodialysis were excluded. Patients were divided into 2 groups according to CRP levels at the end of the 3-month CR/ET: Low-CRP group (CRP<=2.0mg/L, n=414), and High-CRP group (CRP>2.0mg/dl, n=76). Results: At baseline, there were no significant differences between the two groups in age (Low-CRP group 64years vs High-CRP group 63years, NS), body mass index (BMI, 23 vs 23, NS), prevalences of diabetes, smoking habit and statin use, left ventricular ejection fraction (LVEF, 46 vs 44%, NS), or brain natriuretic peptide (BNP) levels (169 vs 164pg/ml, NS). Although the prevalence of dyslipidemia was significantly higher (76% vs 63%, p<0.05), baseline CRP levels (4.5mg/L vs 5.9mg/L, p<0.05) was significantly lower in Low-CRP group than High-CRP group. Notably, Low-CRP group had significantly greater number of attendance in CR/ET in 3 months than High-CRP group (18 vs 14times, p<0.01). Multivariate logistic regression analysis (incorporating age, sex, BMI, history of dyslipidemia, baseline LVEF, peak CK, number of attendance in 3-month CR/ET, BNP, CRP, and statin use) demonstrated that history of dyslipidemia, lower baseline CRP levels, and greater number of 3-month CR/ET attendance were independent determinants (all p<0.05) of achieving CRP levels below 2.0mg/L. Conclusion: Good attendance in CR/ET program is significantly associated with achievement of CRP levels below 2.0mg/L at 3 months, independent of baseline CRP levels, history of dyslipidemia, and statin use.