Cardiovascular Rehabilitation in Patients With Diabetes

Abstract

DEAR EDITOR-IN-CHIEF, W e read with great interest the article by Mourot et al 1 concerning cardiovascular rehabilitation in patients with diabetes. The prevalence of diabetes in patients with coronary artery disease (CAD) is known to be around 31% across Europe (Euro Heart Study) 2 ; thus, the evaluation of the physical performance of this group of patients after a period of cardiac rehabilitation (CR) is a stimulating topic and constitutes a daily issue in most CR units. Mourot et al have focused on 2 aspects of CR in this kind of patients: (1) a multidisciplinary approach (including education) is needed and it has to be tailored to the specific needs of the individual patient and (2) cardiorespiratory fitness is an independent predictor of long-term cardiac mortality in patients with diabetes and CAD and interventions to modify the exercise capacity are relevant, as they could have a positive prognostic impact. The great number of patients included in the study, the similarity of the 2 groups in terms of factors that influence exercise capacity and oxygen uptake (ie, age, sex, ejection fraction), and the accurate evaluation of the physical performance by cardiopulmonary exercise testing, the 6-minute walk test, and evaluation of hand strength make the conclusions of the study very significant. The authors demonstrate that in spite of a higher prevalence of risk factors and a lower initial performance, patients with CAD and diabetes can fully benefit from a multidisciplinary program of CR. However, we have concern about the methodology