Metabolic risk in men with ischaemic heart disease and their participation in ambulatory comprehensive cardiac rehabilitation.

Abstract

With a growing population of patients with ischaemic heart disease (IHD), the number of interventional cardiology and cardiac surgery procedures is also increasing. This is particularly the case for patients with multivessel coronary disease who are treated with percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG). A considerable part of the IHD population are subjects with metabolic syndrome (MetS) who participate in comprehensive cardiac rehabilitation (CCR) programs as a part of secondary prevention of cardiovascular disease. To evaluate prospectively conventional risk factors within MetS, including uric acid (UA) level, in men with IHD after PCI or CABG who participated in ambulatory CCR. The study included 90 adult men (mean age 59.1 ± 7.31 years) with IHD after PCI (n = 63, 70%) or CABG (n = 27, 30%) referred for ambulatory CCR on average 30-60 days after an acute coronary syndrome. All subjects were examined twice 2 months apart - at the referral for CCR and after completion of CCR. MetS was diagnosed based on the measurement of systolic and diastolic blood pressure, waist circumference (WC), and high-density lipoprotein cholesterol, triglyceride (TG), and fasting blood glucose levels. In all subjects, UA level was also measured and the waist-to-hip ratio (WHR) and body mass index (BMI) were calculated. Following clinical evaluation and exercise test, each patient underwent 24 interval training sessions on a cycle ergometer. The patients received drug therapy including beta-blockers, angiotensin-converting enzyme inhibitors, statins, and acetylsalicylic acid. As a part of CCR, the patients also received education regarding healthy lifestyle changes including physical activity, healthy diet, stress coping techniques, effects of nicotine and alcohol, and effective methods to eliminate these habits. In most subjects, WC, BMI and WHR did not change significantly after the period of 2 months of CCR, and WC and BMI increased in the CABG subgroup (p = 0.00003 and p = 0.0178, respectively). Irrespective of the type of cardiac intervention, significant increases in exercise capacity and physical effort tolerance were observed after 2 months of CCR (p < 0.00001). TG level increased in all participants (p = 0.0514) and in the PCI subgroup (p = 0.0489). Systolic blood pressure decreased in all participants (p = 0.0216) and in the PCI subgroup (p = 0.0043). Mean UA level also decreased in all patients regardless of the type of cardiac intervention. Overall, the proportion of patients with the diagnosis of MetS did not change significantly after 2 months of CCR (36% vs. 31%, p > 0.05). However, the rate of MetS decreased in the PCI subgroup (from 46% to 29%, p = 0.043) and increased in the CABG subgroup (from 11% do 37%, p = 0.0562). The effect of participation in CCR on the metabolic risk in men with IHD varies depending on the type of earlier cardiac intervention. The metabolic risk decreased in patients treated with PCI, while it increased in those treated with CABG. In order to reduce the metabolic risk, particularly in CABG patients, a CCR program requires intensification of the patient support including educational activities regarding diet and weight reduction as well as individually prescribed physical activity.