open access
A patient-centered multidisciplinary cardiac rehabilitation program improves glycemic control and functional outcome in coronary artery disease after percutaneous and surgical revascularization
Affiliations- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
- University Heart Center, University Hospital, Zurich, Switzerland
- Cardiocentro Lugano, University of Zurich, Lugano, Switzerland
open access
Abstract
Background: Cardiac rehabilitation (CR) is strongly associated with all-cause mortality reduction in patients with coronary artery disease (CAD). The impact of CR on pathological risk factors, such as impaired glucose tolerance (IGT) and functional recovery remains under debate. The aim of the present study is to determine whether CR had a positive effect beside physical exercise improvement on pathological risk factors in IGT and diabetic patients with CAD.
Methods: One hundred and seventy-one consecutive patients participating in a 3-month CR from January 2014 to June 2015 were enrolled. The primary endpoint was defined as an improvement of peak workload and VO2-peak; glycated hemoglobin (HbA1c) reduction was considered as secondary endpoint.
Results: Euglycemic patients presented a significant improvement in peak workload compared to diabetic patients (from 5.75 ± 1.45 to 6.65 ± 1.84 METs vs. 4.8 ± 0.8 to 4.9 ± 1.4 METs , p = 0.018). VO2-peak improved in euglycemic patients (VO2-peak from 19.3 ± 5.3 to 22.5 ± 5.9 mL/min/kg, p = 0.003), while diabetic patients presented only a statistically significant trend (VO2-peak from 16.9 ± 4.4 to 18.0 ± 3.8 mL/min/kg, p < 0.056). Diabetic patients have benefited more in terms of blood glucose control compared to IGT patients (HbA1c from 7.7 ± 1.0 to 7.4 ± 1.1 compared to 5.6 ± 0.4 to 5.9 ± 0.5, p = 0.02, respectively).
Conclusions: A multidisciplinary CR program improves physical functional capacity in CAD setting, particularly in euglycemic patients. IGT patients as well as diabetic patients may benefit from a CR program, but long-term outcome needs to be clarified in larger studies.
Abstract
Background: Cardiac rehabilitation (CR) is strongly associated with all-cause mortality reduction in patients with coronary artery disease (CAD). The impact of CR on pathological risk factors, such as impaired glucose tolerance (IGT) and functional recovery remains under debate. The aim of the present study is to determine whether CR had a positive effect beside physical exercise improvement on pathological risk factors in IGT and diabetic patients with CAD.
Methods: One hundred and seventy-one consecutive patients participating in a 3-month CR from January 2014 to June 2015 were enrolled. The primary endpoint was defined as an improvement of peak workload and VO2-peak; glycated hemoglobin (HbA1c) reduction was considered as secondary endpoint.
Results: Euglycemic patients presented a significant improvement in peak workload compared to diabetic patients (from 5.75 ± 1.45 to 6.65 ± 1.84 METs vs. 4.8 ± 0.8 to 4.9 ± 1.4 METs , p = 0.018). VO2-peak improved in euglycemic patients (VO2-peak from 19.3 ± 5.3 to 22.5 ± 5.9 mL/min/kg, p = 0.003), while diabetic patients presented only a statistically significant trend (VO2-peak from 16.9 ± 4.4 to 18.0 ± 3.8 mL/min/kg, p < 0.056). Diabetic patients have benefited more in terms of blood glucose control compared to IGT patients (HbA1c from 7.7 ± 1.0 to 7.4 ± 1.1 compared to 5.6 ± 0.4 to 5.9 ± 0.5, p = 0.02, respectively).
Conclusions: A multidisciplinary CR program improves physical functional capacity in CAD setting, particularly in euglycemic patients. IGT patients as well as diabetic patients may benefit from a CR program, but long-term outcome needs to be clarified in larger studies.
Keywords
cardiac rehabilitation, coronary artery disease, diabetes mellitus, reduced glucose tolerance, cardiopulmonary test
About this articleTitle
A patient-centered multidisciplinary cardiac rehabilitation program improves glycemic control and functional outcome in coronary artery disease after percutaneous and surgical revascularization
Journal
Issue
Article type
Original Article
Pages
72-79
Published online
2020-01-21
Page views
6280
Article views/downloads
1296
DOI
10.5603/CJ.a2020.0006
Pubmed
Bibliographic record
Cardiol J 2022;29(1):72-79.
Keywords
cardiac rehabilitation
coronary artery disease
diabetes mellitus
reduced glucose tolerance
cardiopulmonary test
Authors
Andrea Denegri
Valentina A. Rossi
Fabrizio Vaghi
Paolo Di Muro
Martino Regazzi
Tiziano Moccetti
Elena Pasotti
Giovanni B. Pedrazzini
Mauro Capoferri
Marco Moccetti
References (39)- Lüscher TF. Outcomes of acute coronary syndromes: clinical presentation, gender, inflammation, and cell therapy. Eur Heart J. 2017; 38(3): 125–129.
- Anderson L, Thompson DR, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016; 67(1): CD001800–12.
- Rauch B, Davos CH, Doherty P, et al. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol. 2016; 23(18): 1914–1939.
- Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2011(8): CD002902.
- Wong WP, Feng J, Pwee KHo, et al. A systematic review of economic evaluations of cardiac rehabilitation. BMC Health Serv Res. 2012; 12: 243.
- Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–2381.
- Piepoli MF, Corrà U, Adamopoulos S, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol. 2014; 21(6): 664–681.
- Brawner CA, Al-Mallah MH, Ehrman JK, et al. Change in Maximal Exercise Capacity Is Associated With Survival in Men and Women. Mayo Clin Proc. 2017; 92(3): 383–390.
- Vanhees L, Fagard R, Thijs L, et al. Prognostic value of training-induced change in peak exercise capacity in patients with myocardial infarcts and patients with coronary bypass surgery. Am J Cardiol. 1995; 76(14): 1014–1019.
- Rao Kondapally Seshasai S, Kaptoge S, Thompson A, et al. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011; 364(9): 829–841.
- Krempf M, Parhofer KG, Steg PhG, et al. Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (from the REduction of Atherothrombosis for Continued Health [REACH] Registry). Am J Cardiol. 2010; 105(5): 667–671.
- Vergès B, Patois-Vergès B, Cohen M, et al. Effects of cardiac rehabilitation on exercise capacity in Type 2 diabetic patients with coronary artery disease. Diabet Med. 2004; 21(8): 889–895.
- Khosravi A, Gharipour M, Nezafati P, et al. Pre-hypertension, pre-diabetes or both: which is best at predicting cardiovascular events in the long term? J Hum Hypertens. 2017; 31(6): 382–387.
- Russo N, Compostella L, Fadini G, et al. Prediabetes influences cardiac rehabilitation in coronary artery disease patients. Eur J Prev Cardiol. 2012; 19(3): 382–388.
- Milwidsky A, Maor E, Kivity S, et al. Impaired fasting glucose and left ventricular diastolic dysfunction in middle-age adults: a retrospective cross-sectional analysis of 2971 subjects. Cardiovasc Diabetol. 2015; 14: 119.
- Smolis-Bąk E, Rymuza H, Kazimierska B, et al. Improvement of exercise tolerance in cardiopulmonary testing with sustained safety after regular training in outpatients with systolic heart failure (NYHA III) and an implantable cardioverter-defibrillator. Prospective 18-month randomized study. Arch Med Sci. 2017; 13(5): 1094–1101.
- Lim SK, Han JY, Choe YR. Comparison of the Effects of Cardiac Rehabilitation Between Obese and Non-obese Patients After Acute Myocardial Infarction. Ann Rehabil Med. 2016; 40(5): 924–932.
- Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int. 2008; 73(5): 538–546.
- Vergès B, Patois-Vergès B, Iliou MC, et al. DARE Study group. Influence of glycemic control on gain in VO2 peak, in patients with type 2 diabetes enrolled in cardiac rehabilitation after an acute coronary syndrome. The prospective DARE study. BMC Cardiovasc Disord. 2015; 15: 64.
- Colbert JD, Martin BJ, Haykowsky MJ, et al. Cardiac rehabilitation referral, attendance and mortality in women. Eur J Prev Cardiol. 2015; 22(8): 979–986.
- Nilsson BB, Lunde P, Grøgaard HK, et al. Long-Term Results of High-Intensity Exercise-Based Cardiac Rehabilitation in Revascularized Patients for Symptomatic Coronary Artery Disease. Am J Cardiol. 2018; 121(1): 21–26.
- Jaureguizar KV, Vicente-Campos D, Bautista LR, et al. Effect of High-Intensity Interval Versus Continuous Exercise Training on Functional Capacity and Quality of Life in Patients With Coronary Artery Disease: A RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev. 2016; 36(2): 96–105.
- Gregg E, Jakicic J, Blackburn G, et al. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2016; 4(11): 913–921.
- Gardiner FW, Regan E, Nwose EU, et al. Outpatient cardiac rehabilitation: Effects on patient improvement outcomes. Diabetes Metab Syndr. 2017; 11 Suppl 2: S1025–S1030.
- Albright A, Franz M, Hornsby G, et al. American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc. 2000; 32(7): 1345–1360.
- Marwick TH, Hordern MD, Miller T, et al. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009; 119(25): 3244–3262.
- Pack QR, Goel K, Lahr BD, et al. Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery: a community-based study. Circulation. 2013; 128(6): 590–597.
- Younce CW, Wang K, Kolattukudy PE. Hyperglycaemia-induced cardiomyocyte death is mediated via MCP-1 production and induction of a novel zinc-finger protein MCPIP. Cardiovasc Res. 2010; 87(4): 665–674.
- Su H, Ji L, Xing W, et al. Acute hyperglycaemia enhances oxidative stress and aggravates myocardial ischaemia/reperfusion injury: role of thioredoxin-interacting protein. J Cell Mol Med. 2013; 17(1): 181–191.
- Toste S, Viamonte S, Barreira A, et al. Cardiac rehabilitation in patients with type 2 diabetes mellitus and coronary disease: a comparative study. Rev Port Cardiol. 2014; 33(10): 599–608.
- Sabbag A, Mazin I, Rott D, et al. The prognostic significance of improvement in exercise capacity in heart failure patients who participate in cardiac rehabilitation programme. Eur J Prev Cardiol. 2018; 25(4): 354–361.
- Giallauria F, Fattirolli F, Tramarin R, et al. Clinical characteristics and course of patients with diabetes entering cardiac rehabilitation. Diabetes Res Clin Pract. 2015; 107(2): 267–272.
- Savage PD, Antkowiak M, Ades PA. Failure to improve cardiopulmonary fitness in cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2009; 29(5): 284–91; quiz 292.
- Vergès B, Patois-Vergès B, Cohen M, et al. Effects of cardiac rehabilitation on exercise capacity in Type 2 diabetic patients with coronary artery disease. Diabet Med. 2004; 21(8): 889–895.
- Banzer JA, Maguire TE, Kennedy CM, et al. Results of cardiac rehabilitation in patients with diabetes mellitus. Am J Cardiol. 2004; 93(1): 81–84.
- Fang ZY, Sharman J, Prins JB, et al. Determinants of exercise capacity in patients with type 2 diabetes. Diabetes Care. 2005; 28(7): 1643–1648.
- Lakshmanan AP, Harima M, Suzuki K, et al. The hyperglycemia stimulated myocardial endoplasmic reticulum (ER) stress contributes to diabetic cardiomyopathy in the transgenic non-obese type 2 diabetic rats: a differential role of unfolded protein response (UPR) signaling proteins. Int J Biochem Cell Biol. 2013; 45(2): 438–447.
- Pang Yi, Hunton DL, Bounelis P, et al. Hyperglycemia inhibits capacitative calcium entry and hypertrophy in neonatal cardiomyocytes. Diabetes. 2002; 51(12): 3461–3467.
- Kelley DE, He J, Menshikova EV, et al. Dysfunction of Mitochondria in Human Skeletal Muscle in Type 2 Diabetes. Diabetes. 2002; 51(10): 2944–2950.
