Abstract
BackgroundThe prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM.Methods1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO2 peak), body mass index, resting systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression.Results430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO2 peak. 12-month cardiac mortality was higher in patients with DM.ConclusionsWhile immediate improvements in VO2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short- and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR.Trial registration NTR5306 at trialregister.nl; trial registered 07/16/2015; https://www.trialregister.nl/trial/5166
Highlights
The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly
Clinical benefits of exercise-based cardiovascular rehabilitation (CR) programmes have been assessed in younger diabetic populations [13,14,15,16,17] with some studies finding comparable improvements in cardiovascular risk factor management [13, 14, 16, 17], and some finding smaller benefits of cardiac rehabilitation (CR) [15] in patients with DM compared to non-diabetic patients
Our study showed that benefits with CR may be comparable between elderly patients with and without DM over the duration of CR, but were poorer over 1 year followup in diabetic patients with regard to exercise capacity and High-density lipoprotein cholesterol (HDL-C)
Summary
The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with cardiovascular disease, in elderly patients, since many risk factors are shared. In elderly patients with T2DM, studies have commonly employed resistance training, in an attempt to address age-related muscle loss and fat infiltration into muscle tissue, which is a common problem in these patients [9]. These studies have been successful at improving muscle force and glycemic control [10, 11]. No studies on clinical benefits of CR or hard outcomes have focussed on an elderly population with DM, and only one very small study has investigated outcomes at 1-year follow-up [19]
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