Abstract
Structured lifestyle interventions through cardiac rehabilitation (CR) are critical to improving the outcome of patients with cardiovascular disease (CVD) and cardiometabolic risk factors. CR programs’ variability in real-world practice may impact CR effects. This study evaluates intensive CR (ICR) and standard CR (SCR) programs for improving cardiometabolic, psychosocial, and clinical outcomes in high-risk CVD patients undergoing guideline-based therapies. Both programs provided lifestyle counseling and the same supervised exercise component. ICR additionally included a specialized plant-based diet, stress management, and social support. Changes in body weight (BW), low-density lipoprotein cholesterol (LDL-C), and exercise capacity (EC) were primary outcomes. A total of 314 patients (101 ICR and 213 SCR, aged 66 ± 13 years, 75% overweight/obese, 90% coronary artery disease, 29% heart failure, 54% non-optimal LDL-C, 43% depressive symptoms) were included. Adherence to ICR was 96% vs. 68% for SCR. Only ICR resulted in a decrease in BW (3.4%), LDL-C (11.3%), other atherogenic lipids, glycated hemoglobin, and systolic blood pressure. Both ICR and SCR increased EC (52.2% and 48.7%, respectively) and improved adiposity indices, diastolic blood pressure, cholesterol intake, depression, and quality of life, but more for ICR. Within 12.6 ± 4.8 months post-CR, major adverse cardiac events were less likely in the ICR than SCR group (11% vs. 17%), especially heart failure hospitalizations (2% vs. 8%). A comprehensive ICR enhanced by a plant-based diet and psychosocial management is feasible and effective for improving the outcomes in high-risk CVD patients in real-world practice.
Highlights
Cardiovascular disease (CVD) is the main cause of morbidity and mortality, and the coronary artery disease (CAD) is a leading cause of death [1,2,3]
A comprehensive multi-component intensive CR (ICR) program enhanced by a plant-based diet and psychosocial management resulted in significant improvements in cardiometabolic and psychosocial outcomes, and there were trends suggesting a reduction in long-term major adverse cardiac events (MACEs)
We demonstrate that a comprehensive multifactorial ICR program resulted in significant improvements in cardiometabolic outcomes in high-risk patients with various types of CVD, including CAD and chronic heart failure (HF), severe comorbidities such as type 2 diabetes mellitus (T2D) and chronic kidney disease (CKD), and persistent CV risk factors such as elevated body weight (BW) and low-density lipoprotein cholesterol (LDL-C), despite guideline-based therapies
Summary
Cardiovascular disease (CVD) is the main cause of morbidity and mortality, and the coronary artery disease (CAD) is a leading cause of death [1,2,3]. The burden of CVD continues to increase due to the high prevalence of cardiovascular (CV) risk factors such as obesity, elevated atherogenic lipids and blood pressure (BP), type 2 diabetes mellitus (T2D), an inadequate diet, low physical activity, chronic inflammation, and smoking [1,2,3,4,5]. Secondary prevention modalities including evidence-based pharmacotherapy and comprehensive risk factor management such as reducing body weight (BW) and low-density lipoprotein cholesterol level (LDL-C), controlling BP, increasing physical activity, and optimizing an unhealthy diet improve the outcomes of patients with established CVD [9,10,11,12,13,14,15]. Diet/nutritional and physical activity counseling, along with weight control, lipid and BP management, and psychosocial interventions are considered as the core components of modern CR programs [21]
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