Abstract
Background: Cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) increases adherence to a healthy lifestyle and to secondary preventive medication. A notable example of such medication is lipid-lowering therapy (LLT). LLT during CR improves quality of life and prognosis, and thus is particularly relevant for patients with diabetes mellitus, which is a major risk factor for CHD. Design: A prospective, multicenter registry study with patients from six rehabilitation centers in Germany. Methods: During CR, 1100 patients with a minimum age of 18 years and CHD documented by coronary angiography were included in a LLT registry. Results: In 369 patients (33.9%), diabetes mellitus was diagnosed. Diabetic patients were older (65.5 ± 9.0 vs. 62.2 ± 10.9 years, p < 0.001) than nondiabetic patients and were more likely to be obese (BMI: 30.2 ± 5.2 kg/m2 vs. 27.8 ± 4.2 kg/m2, p < 0.001). Analysis indicated that diabetic patients were more likely to show LDL cholesterol levels below 55 mg/dL than patients without diabetes at the start of CR (Odds Ratio (OR) 1.9; 95% CI 1.3 to 2.9) until 3 months of follow-up (OR 1.9; 95% CI 1.2 to 2.9). During 12 months of follow-up, overall and LDL cholesterol levels decreased within the first 3 months and remained at the lower level thereafter (p < 0.001), irrespective of prevalent diabetes. At the end of the follow-up period, LDL cholesterol did not differ significantly between patients with or without diabetes mellitus (p = 0.413). Conclusion: Within 3 months after CR, total and LDL cholesterol were significantly reduced, irrespective of prevalent diabetes mellitus. In addition, CHD patients with diabetes responded faster to LTT than nondiabetic patients, suggesting that diabetic patients benefit more from LLT treatment during CR.
Highlights
Diabetes mellitus constitutes a major risk factor for developing coronary heart disease (CHD), and potentiates the risk for fatal events in patients who already have CHD [1].Standard treatment of CHD in patients with and without diabetes typically comprises a combination of lifestyle changes, e.g., physical activity on a regular basis, cessation 4.0/).of smoking, adoption of a healthier diet, and secondary preventive medication
Standard treatment of CHD in patients with and without diabetes typically comprises a combination of lifestyle changes, e.g., physical activity on a regular basis, cessation of smoking, adoption of a healthier diet, and secondary preventive medication
Cardiac rehabilitation (CR) commonly implements intensive programs on five days a week, including psychosocial support, physical exercise, and nutrition counseling [18]. In this analysis of the German multicenter Lipid-Lowering-Therapy-Rehabilitation registry (LLT-R), we focused on the effect of lipid-lowering therapy (LLT) in patients with diabetes mellitus and CHD
Summary
Diabetes mellitus constitutes a major risk factor for developing coronary heart disease (CHD), and potentiates the risk for fatal events in patients who already have CHD [1].Standard treatment of CHD in patients with and without diabetes typically comprises a combination of lifestyle changes, e.g., physical activity on a regular basis, cessation 4.0/).of smoking, adoption of a healthier diet, and secondary preventive medication. Diabetes mellitus constitutes a major risk factor for developing coronary heart disease (CHD), and potentiates the risk for fatal events in patients who already have CHD [1]. The medical consensus recommends lipid-lowering therapy (LLT) for all patients who have developed CHD, irrespective of whether they have diabetes [4,5]. This treatment is independent of the initial level of low-density lipoprotein (LDL) cholesterol. Methods: During CR, 1100 patients with a minimum age of years and CHD documented by coronary angiography were included in a LLT registry. Analysis indicated that diabetic patients were more likely to show LDL cholesterol levels below 55 mg/dL than patients without diabetes at the start of CR (Odds Ratio (OR) 1.9; 95% CI 1.3 to 2.9) until 3 months of follow-up
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