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Fatahian F, Mohammadifard N, Hassanzadeh A, Shahnazi H. The effect of a health belief model-based education on nutritional behavior and biochemical factors of patients with myocardial infarction: A line follow-up experimental study. Health Sci Rep 2024; 7:e1966. [PMID: 38463034 PMCID: PMC10920927 DOI: 10.1002/hsr2.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/12/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Background and Aim Myocardial infarction is a common cause of hospitalization, and nutritional behaviors are risk factors in such patients. The present study aimed to determine the effect of education based on the health belief model on nutritional behavior and indices in patients with myocardial infarction. Methods The present experimental study examined patients with myocardial infarction in 2021. Seventy-two patients with myocardial infarction were randomly divided into intervention and control groups. The intervention group received educational interventions based on the health belief model in four 60-min sessions for 3 months. The constructs of the health belief model, nutritional behavior, and indices were measured using a valid questionnaire before, 1, and 3 months after the intervention. At the end, the study data was analyzed using SPSS version 22 software. Results There was a significant difference between the two groups in the mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, nutritional behaviors, and body mass index after the intervention (p < 0.05); however, no significant difference was found in the field of perceived barriers (p > 0.05). Biochemical factors also had a significant difference after the intervention (p < 0.05). Conclusion Educational intervention based on the health belief model is effective for myocardial infarction patients and has a significant impact on the constructs of perceived sensitivity, perceived intensity, perceived benefits, and self-efficacy as well as biochemical factors, so it can be used to improve the nutritional status of patients suffered from a myocardial infarction.
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Affiliation(s)
- Fatemeh Fatahian
- School of HealthIsfahan University of Medical SciencesIsfahanIran
| | - Noushin Mohammadifard
- Cardiovascular Research Center, Cardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
| | - Akbar Hassanzadeh
- Department of Epidemiology and BiostatisticsIsfahan University of Medical SciencesIsfahanIran
| | - Hossein Shahnazi
- Department of Health Education and Health Promotion, School of HealthIsfahan University of Medical SciencesIsfahanIran
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Perone F, Pingitore A, Conte E, Halasz G, Ambrosetti M, Peruzzi M, Cavarretta E. Obesity and Cardiovascular Risk: Systematic Intervention Is the Key for Prevention. Healthcare (Basel) 2023; 11:healthcare11060902. [PMID: 36981559 PMCID: PMC10048800 DOI: 10.3390/healthcare11060902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Obesity is a serious public health issue and associated with an increased risk of cardiovascular disease events and mortality. The risk of cardiovascular complications is directly related to excess body fat mass and ectopic fat deposition, but also other obesity-related complications such as pre-type 2 diabetes, obstructive sleep apnoea, and non-alcoholic fatty liver diseases. Body mass index and waist circumference are used to classify a patient as overweight or obese and to stratify cardiovascular risk. Physical activity and diet, despite being key points in preventing adverse events and reducing cardiovascular risk, are not always successful strategies. Pharmacological treatments for weight reduction are promising strategies, but are restricted by possible safety issues and cost. Nonetheless, these treatments are associated with improvements in cardiovascular risk factors, and studies are ongoing to better evaluate cardiovascular outcomes. Bariatric surgery is effective in reducing the incidence of death and cardiovascular events such as myocardial infarction and stroke. Cardiac rehabilitation programs in obese patients improve cardiovascular disease risk factors, quality of life, and exercise capacity. The aim of this review was to critically analyze the current role and future aspects of lifestyle changes, medical and surgical treatments, and cardiac rehabilitation in obese patients, to reduce cardiovascular disease risk and mortality, and to highlight the need for a multidisciplinary approach to improving cardiovascular outcomes.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa delle Magnolie", 81020 Castel Morrone, Caserta, Italy
| | - Annachiara Pingitore
- Department of General and Specialistic Surgery "Paride Stefanini", Sapienza University of Rome, 00161 Rome, Italy
| | - Edoardo Conte
- Department of Clinical Cardiology and Cardiovascular Imaging, Galeazzi-Sant'Ambrogio Hospital IRCCS, 20100 Milan, Lombardy, Italy
| | - Geza Halasz
- Cardiology Department, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema Santa Marta Hospital, 26027 Rivolta D'Adda, Cremona, Italy
| | - Mariangela Peruzzi
- Department of Clinical Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Mediterranea Cardiocentro, 80122 Naples, Campania, Italy
| | - Elena Cavarretta
- Mediterranea Cardiocentro, 80122 Naples, Campania, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Latina, Italy
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Echocardiographic follow-up after cardiac rehabilitation designed for patients with obesity. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:945-954. [PMID: 36928518 PMCID: PMC10160212 DOI: 10.1007/s10554-023-02805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/27/2023] [Indexed: 03/18/2023]
Abstract
We hypothesize that a novel tailor-made cardiac rehabilitation (CR) program for obesity patients (OPTICARE XL) has better outcomes as compared to usual CR regarding parameters of cardiac function as measured by conventional and advanced transthoracic echocardiography. This is an open-label, randomized controlled trial. Inclusion criteria were: patients referred to CR with a body mass index (BMI) ≥30 kg/m2, and age ≥18 years with either coronary artery disease or nonvalvular atrial fibrillation. The experimental group participated in OPTICARE XL and the controls received the usual CR. Subjects randomized to OPTICARE XL received on top of usual CR behavioural therapy for a healthy diet and an active lifestyle for the first 12 weeks. Also, the exercise program was more tailored. Furthermore, a behavioural after-care program was organized with 6 meetings between weeks 13-52. Transthoracic (speckle tracking) echocardiography was performed at baseline and one-year follow-up. A total of 42 patients completed the follow-up, 21 in both groups. There was a mild but statistically significant reduction in weight over time, however, this was comparable between groups. There was no improvement observed in any of the echocardiographic parameters. In conclusion, cardiac function in obesity patients was not improved one-year after a novel tailor-made CR program (OPTICARE XL) as compared to usual CR.
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Abstract
Cardiovascular diseases (CVD) remain the leading cause of death globally, and further efforts are being undertaken to understand and modify CVD risk factors, such as dyslipidemia (DLD), hypertension, and diabetes. The sedentary lifestyle of most individuals today contributes to the prevalence of these conditions. Uncontrolled dyslipidemia serves as a fertile ground for atherosclerotic plaque formation, while lipoproteins (Lp) act as cofactors for inflammatory processes that cause plaque destabilization leading to subsequent CVD events. As such, many health experts and institutions continue to emphasize the importance of cardiorespiratory fitness (CRF) and muscular strength (MusS) with the intent to reduce atherogenic lipoproteins and proprotein convertase subtilisin kexin type 9 (PCSK-9) expression. Concordantly, the two modes of exercise training (ET), such as aerobic ET (aET) and resistance ET (rET) have both demonstrated to improve CRF and MusS, respectively. Although both modes of ET were shown to independently reduce mortality, participation in both forms resulted in a more pronounced improvement in cholesterol levels and CVD-related mortality. Though reduction of adiposity is not a pre-requisite to achieve better control of DLD through increased CRF and MusS, the beneficial effects of physical activity on the inflammatory processes linked to atherosclerosis are almost always associated with a simultaneous decrease in overall adiposity. It is therefore essential to promote both aET and rET, including weight loss in order to attenuate the risks stemming from atherosclerosis and its proinflammatory components.
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Obesity Paradox of All-Cause Mortality in 4,133 Patients Treated with Coronary Revascularization. J Interv Cardiol 2021; 2021:3867735. [PMID: 34887705 PMCID: PMC8616700 DOI: 10.1155/2021/3867735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/02/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives The purpose of this study was to determine whether there is a dose-response relationship between body mass index (BMI) and all-cause mortality in patients after coronary revascularization. Methods The MIMIC-III database (version 1.4) was used as the sample population. For variables with less than 10% of values missing, we used the mice package of R software for multiple imputations. Cox regression was used to determine the risk factors of all-cause mortality in patients. RCSs were used to observe the relationship between BMI and all-cause mortality. Additional subgroup and sensitivity analyses were also performed to explore whether the conclusion can be applied to specific groups. Results Both univariate and multivariate Cox models indicated that the mortality risk was lower for overweight patients than for normal-weight patients (P < 0.05). In RCS models, BMI had a U-shaped relationship with all-cause mortality of patients after coronary artery bypass grafting (CABG) (P for nonlinearity = 0.0028). There was a weak U-shaped relationship between BMI and all-cause mortality after percutaneous coronary intervention (PCI), but the nonlinear relationship between these two parameters was not significant (P for nonlinearity = 0.1756). Conclusions The obesity paradox does exist in patients treated with CABG and PCI. RCS analysis indicated that there was a U-shaped relationship between BMI and all-cause mortality in patients after CABG. After sex stratification, the relationship between BMI and all-cause mortality in male patients who received PCI was L-shaped, while the nonlinear relationship among females was not significant.
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Abstract
The World Health Organization has declared obesity to be a global epidemic that increases cardiovascular disease (CVD) mortality risk factors, such as hypertension, diabetes, dyslipidemia, and atherosclerosis. The increasing ratio of time spent in sedentary activities to that spent performing physically demanding tasks increases the trends to obesity and susceptibility to these risk factors. Dyslipidemia is the foundation of atherosclerotic buildup and lipoproteins serve as cofactors to the inflammatory processes that destabilize plaques. Increasing cardiorespiratory fitness and muscular strength helps attenuate concentrations of low-density lipoproteins (LDLs), such as LDL cholesterol, and increase levels of high-density lipoprotein cholesterol, as well as reduce proprotein convertase subtilisin kexin type 9 expression. Effects of physical activity on the inflammatory pathways of atherosclerosis, specifically C-reactive protein, are more closely related to reducing the levels of adiposity in tandem with increasing fitness, than with exercise training alone. The purpose of this review is to describe the physiology of dyslipidemia and relate it to CVD and exercise therapies.
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Nichols S, McGregor G, Breckon J, Ingle L. Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure. Int J Sports Med 2020; 42:19-26. [PMID: 32650344 DOI: 10.1055/a-1198-5573] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient's priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The 'dose' of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.
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Affiliation(s)
- Simon Nichols
- Sheffield Hallam University Centre for Sports and Exercise Science, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Gordon McGregor
- University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, Coventry University, United Kingdom of Great Britain and Northern Ireland
| | - Jeff Breckon
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Hull, United Kingdom of Great Britain and Northern Ireland
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Abstract
Coronary artery disease (CAD) can be obstructive or nonobstructive. Patients with nonobstructive and stable angina pectoris are usually women. Nonobstructive CAD is caused by endothelial dysfunction at the microvascular level, such as cardiac syndrome X and coronary slow flow syndrome. Even if coronary anatomy is nonobstructive, the presence of myocardial ischemia is a major determinant for the exercise program. CAD is a chronic inflammatory disease, and the progression of the disease can lead to a rapid change in the functional capacity of CAD patients. Exercise training is a major component of cardiac rehabilitation and reduces cardiovascular mortality, morbidity, and rehospitalization as well as improves psychological stress and controls risk factors of CAD, such as diabetes mellitus, hypertension, and obesity. It is possible that the quality of life of patients with CAD can be improved by using appropriate exercise therapy. However, the exercise programs among CAD patients are highly underutilized. This chapter will summarize the research progress of exercise in the prevention and treatment of CAD as well as how to create safe exercise programs and the importance of exercise for patients with CAD. In addition, exercise training has fundamental beneficial effects on ischemic and nonischemic heart failure.
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Affiliation(s)
- Aydin Akyuz
- Faculty of Medicine, Department of Cardiology, University Hospital, Namık Kemal University, Tekirdag, Turkey.
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Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism 2019; 92:98-107. [PMID: 30399375 DOI: 10.1016/j.metabol.2018.10.011] [Citation(s) in RCA: 367] [Impact Index Per Article: 73.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023]
Abstract
A wealth of clinical and epidemiological evidence has linked obesity to a broad spectrum of cardiovascular diseases (CVD) including coronary heart disease, heart failure, hypertension, stroke, atrial fibrillation and sudden cardiac death. Obesity can increase CVD morbidity and mortality directly and indirectly. Direct effects are mediated by obesity-induced structural and functional adaptations of the cardiovascular system to accommodate excess body weight, as well as by adipokine effects on inflammation and vascular homeostasis. Indirect effects are mediated by co-existing CVD risk factors such as insulin resistance, hyperglycemia, hypertension and dyslipidemia. Adipose tissue (AT) quality and functionality are more relevant aspects for cardiometabolic risk than its total amount. The consequences of maladaptive AT expansion in obesity are local and systemic: the local include inflammation, hypoxia, dysregulated adipokine secretion and impaired mitochondrial function; the systemic comprise insulin resistance, abnormal glucose/lipid metabolism, hypertension, a pro-inflammatory and pro-thrombotic state and endothelial dysfunction, all of which provide linking mechanisms for the association between obesity and CVD. The present narrative review summarizes the major pathophysiological links between obesity and CVD (traditional and novel concepts), analyses the heterogeneity of obesity-related cardiometabolic consequences, and provides an overview of the cardiovascular impact of weight loss interventions.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
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Sadeghi M, Khosravi-Broujeni H, Salehi-Abarghouei A, Heidari R, Masoumi G, Roohafza H. Effect of cardiac rehabilitation on inflammation: A systematic review and meta-analysis of controlled clinical trials. ARYA ATHEROSCLEROSIS 2018; 14:85-94. [PMID: 30108640 PMCID: PMC6087630 DOI: 10.22122/arya.v14i2.1489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to assess the effect of cardiac rehabilitation (CR) on serum C-reactive protein (CRP) as an indicator of the inflammatory state and predictor of recurrent cardiovascular events. METHODS PubMed, SCOPUS, Cochrane library, and Google Scholar databases were searched up to January 2014 for original articles which investigated the effect of CR on CRP among adult patients with previous cardiovascular events. The random effects model was used to assess the overall effect of CR on the variation in serum CRP levels. RESULTS In the present systematic review and meta-analysis, 15 studies were included. The analysis showed that CR might significantly reduce high-sensitivity CRP (hs-CRP) levels [Difference in means (DM) = -1.81 mg/l, 95% confidence interval (CI): -2.65, -0.98; P = 0.004). However, the heterogeneity between studies was significant (Cochran's Q test, P < 0.001, I-squared = 84.9%). To find the source of variation, the studies were categorized based on study design (quality) and duration. The negative effect was higher among studies which followed their participants for 3 weeks or less (DM = -2.75 mg/l, 95% CI: -3.86, -1.64; P < 0.001) compared to studies which investigated the effect of CR for 3-8 weeks (DM = -0.89 mg/l, 95% CI: -1.35, -0.44; P < 0.001) and those which lasted more than 8 weeks (DM = -1.71 mg/l, 95% CI: -2.53, -0.89; P < 0.001). There was no evidence of heterogeneity when the categorization was based on the follow-up period. CONCLUSION Both short- and long-term CR have resulted in improvement in serum hs-CRP levels. CR can be perceived as a beneficial tool to reduce inflammatory markers among patients with previous cardiac events.
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Affiliation(s)
- Masoumeh Sadeghi
- Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Khosravi-Broujeni
- School of Medicine AND Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Amin Salehi-Abarghouei
- Assistant Professor, Nutrition and Food Security Research Center AND Department of Nutrition, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ramin Heidari
- Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Masoumi
- Associate Professor, Cardiac Anesthesiology Research Center, Chamran Heart Center Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Assistant Professor, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Heinl RE, Dhindsa DS, Mahlof EN, Schultz WM, Ricketts JC, Varghese T, Esmaeeli A, Allard-Ratick MP, Millard AJ, Kelli HM, Sandesara PB, Eapen DJ, Sperling L. Comprehensive Cardiovascular Risk Reduction and Cardiac Rehabilitation in Diabetes and the Metabolic Syndrome. Can J Cardiol 2016; 32:S349-S357. [PMID: 27692115 PMCID: PMC5320578 DOI: 10.1016/j.cjca.2016.07.507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/23/2016] [Accepted: 07/08/2016] [Indexed: 02/06/2023] Open
Abstract
The epidemic of obesity has contributed to a growing burden of metabolic syndrome (MetS) and diabetes mellitus (DM) worldwide. MetS is defined as central obesity along with associated factors such as hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, and hypertension. MetS and DM are associated with significant cardiovascular morbidity and mortality. Healthy behavioural modification is the cornerstone for reducing the atherosclerotic cardiovascular disease burden in this population. Comprehensive, multidisciplinary cardiac rehabilitation (CR) programs reduce mortality and hospitalizations in patients with MetS and DM. Despite this benefit, patients with MetS and DM are less likely to attend and complete CR because of numerous barriers. Implementation of innovative CR delivery models might improve utilization of CR and cardiovascular outcomes in this high-risk population.
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Affiliation(s)
- Robert E Heinl
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Devinder S Dhindsa
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elliot N Mahlof
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William M Schultz
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Johnathan C Ricketts
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tina Varghese
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amirhossein Esmaeeli
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marc P Allard-Ratick
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anthony J Millard
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Heval M Kelli
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Pratik B Sandesara
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Danny J Eapen
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Laurence Sperling
- Division of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA.
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Khadanga S, Savage PD, Ades PA. Insulin Resistance and Diabetes Mellitus in Contemporary Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2016; 36:331-8. [PMID: 27182762 PMCID: PMC5048191 DOI: 10.1097/hcr.0000000000000187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The goal of this study was to determine the prevalence of insulin resistance (IR) and type 2 diabetes mellitus (T2DM) in contemporary cardiac rehabilitation (CR) and to compare clinical responses in CR between these subsets of patients with coronary heart disease (CHD). METHODS The study cohort included 818 patients enrolled in CR and separated into 3 groups: (1) individuals with normal hemoglobin A1c (HbA1c) (NoIR: HbA1c < 5.7%); (2) individuals with IR (IR: HbA1c ≥ 5.7 to <6.5%); (3) and individuals with T2DM (HbA1c ≥ 6.5%). RESULTS The combined prevalence of IR (44%) and T2DM (23%) was 67%, which paralleled the prevalence of metabolic syndrome (MetSyn), present in 65% of patients. Women had a higher prevalence of IR and MetSyn than men (73% vs 64%, 72% vs. 63%, respectively) and a greater percentage with an elevated waist circumference (71% vs 60%) (all P < .05). All 3 groups experienced decreases in body weight (NoIR = -2.3 ± 4.0, IR = -1.7 ± 4.0, T2DM = -1.0 ± 4.2 kg) and increases in maximal metabolic equivalents (METs) at exercise testing (NoIR = +2.2 ± 2.5 vs IR = +2.1 ± 2.8 vs T2DM = +1.3 ± 2.3) (all P < .05). Individuals with NoIR achieved greater improvements in weight, body mass index, and METs than patients with T2DM (all P < .05). Selected individuals who participated in a 4-session behavioral weight-loss program lost more than twice the weight as nonparticipants. CONCLUSIONS The combined prevalence of IR and T2DM in patients with CHD enrolled in CR was remarkably high (67%). To reverse the deleterious consequences of IR and T2DM, targeted interventions involving exercise and weight loss need to be a central focus of CR programming.
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Affiliation(s)
- Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont Medical Center, Burlington
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13
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Reporting of Posttraumatic Stress Disorder and Cardiac Misconceptions Following Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2016; 35:238-45. [PMID: 25689163 DOI: 10.1097/hcr.0000000000000100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Approximately 15% of cardiac patients experience posttraumatic stress disorder (PTSD), double the incidence seen in the general community. Posttraumatic stress disorder can seriously affect psychological and physical recovery. This study assessed how many patients reported symptoms of PTSD following a cardiac event and examined whether there was any change after completing a cardiac rehabilitation (CR) program. Associations between PTSD and anxiety, depression, and cardiac misconceptions were also explored. METHODS This was a prospective cohort study using repeated measures. All patients eligible for the hospital CR program were invited to complete questionnaires assessing psychological distress and beliefs about heart disease before (T1) and after (T2) completing the CR program. RESULTS Questionnaires at T1 were returned by 105 patients. Of these, 24% reported symptoms of PTSD, 18% high anxiety, and 9% high levels of depression. At T2, 67 patients returned questionnaires, showing that 9% of patients continued to experience PTSD. These patients experienced significantly higher levels of anxiety (t = -4.77; P < .001) and depression (t = -3.64; P < .001). Intrusive thoughts and hyperarousal were significantly lower at T2 (t = 2.32; P = .02 and t = 3.01; P = .01, respectively). More misconceptions were associated with higher levels of anxiety and depression; however, the number of cardiac misconceptions remained similar throughout. Caucasians reported significantly fewer misconceptions than non-Caucasian patients, except for beliefs about myocardial infarction. Patients had fewer misconceptions about their own specific condition. CONCLUSIONS These findings suggest that screening for symptoms of PTSD after completion of a CR program would be helpful in identifying patients who would benefit from specialist psychological support.
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Socioeconomic and Behavioral Characteristics Associated With Metabolic Syndrome Among Overweight/Obese School-age Children. J Cardiovasc Nurs 2015; 32:30-38. [PMID: 26544172 DOI: 10.1097/jcn.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity in children comprises a significant public health concern in Korea. As with increased prevalence of overweight and obesity among children, risk factors for metabolic syndrome (MetS) have also increased in this population. OBJECTIVE The purpose was to examine behavioral and socioeconomic factors that were associated with biomarkers of MetS among overweight/obese school-age children. METHODS A cross-sectional study was conducted, and a convenience sample of 75 overweight/obese school-age children participated. Socioeconomic and behavioral characteristics, anthropometric measurements, and physiologic examinations were studied. The data were analyzed using an analysis of covariance and logistic regression. RESULTS Metabolic syndrome was diagnosed in 27.8% of our population. Severe stress was significantly associated with elevated systolic blood pressure (P < .05). Among the family characteristics, children's perception of family income (wealthy and very wealthy) and mother's education level (high school or less) were associated with diagnoses of MetS in children (P < .05). CONCLUSIONS The results indicated that certain socioeconomic and behavioral characteristics were associated with risk factors of MetS, and therefore, interventions to modify these risk factors are needed to promote the healthy development of overweight/obese school-age children.
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15
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Diletti R, Garcia-Garcia HM, Bourantas C, Van Mieghem NM, van Geuns RJ, Muramatsu T, Zhang YJ, Mauri L, Belardi J, Silber S, Widimsky P, Leon M, Windecker S, Meredith I, Neumann FJ, Yeung AC, Saito S, Liu M, van Leeuwen F, Serruys PW. Impact of body mass index on long-term clinical outcomes after second-generation drug eluting stent implantation: Insights from the international global RESOLUTE program. Catheter Cardiovasc Interv 2015; 85:952-8. [PMID: 25689692 DOI: 10.1002/ccd.25828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 01/03/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND An increased body mass index (BMI) is associated with a high risk of cardiovascular disease and reduction in life expectancy. However, several studies reported improved clinical outcomes in obese patients treated for cardiovascular diseases. The aim of the present study is to investigate the impact of BMI on long-term clinical outcomes after implantation of zotarolimus eluting stents. METHODS Individual patient data were pooled from the RESOLUTE Clinical Program comprising five trials worldwide. The study population was sorted according to BMI tertiles and clinical outcomes were evaluated at 2-year follow-up. RESULTS Data from a total of 5,127 patients receiving the R-ZES were included in the present study. BMI tertiles were as follow: I tertile (≤ 25.95 kg/m(2) -Low or normal weight) 1,727 patients; II tertile (>25.95 ≤ 29.74 kg/m(2) -overweight) 1,695 patients, and III tertile (>29.74 kg/m(2) -obese) 1,705 patients. At 2-years follow-up no difference was found for patients with high BMI (III tertile) compared with patients with normal or low BMI (I tertile) in terms of target lesion failure (I-III tertile, HR [95% CI] = 0.89 [0.69, 1.14], P = 0.341; major adverse cardiac events (I-III tertile, HR [95% CI] = 0.90 [0.72, 1.14], P = 0.389; cardiac death (I-III tertile, HR [95% CI] = 1.20 [0.73, 1.99], P = 0.476); myocardial infarction (I-III tertile, HR [95% CI] = 0.86 [0.55, 1.35], P = 0.509; clinically-driven target lesion revascularization (I-III tertile, HR [95% CI] = 0.75 [0.53, 1.08], P = 0.123; definite or probable stent thrombosis (I-III tertile, HR [95% CI] = 0.98 [0.49, 1.99], P = 0.964. CONCLUSIONS In the present study, the patients' body mass index was found to have no impact on long-term clinical outcomes after coronary artery interventions.
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Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Gender, race and cardiac rehabilitation in the United States: is there a difference in care? Am J Med Sci 2014; 348:146-52. [PMID: 25010188 DOI: 10.1097/maj.0000000000000306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Coronary heart disease is the leading cause of death within the United States, involving both genders and among all races and ethnic populations. Cardiac rehabilitation (CR) has been shown to significantly improve morbidity and mortality, and these benefits extend to individuals of both genders and all ages with coronary heart disease. Despite this, referral and participation rates remain surprisingly low. Furthermore, women and minorities have even lower referral rates than do their male and white counterparts. Over the course of this article, we will review CR referral and participation among women, as well as racial and ethnic minorities in the United States. We will also examine barriers to CR participation among these subgroups.
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Blum MR, Schmid JP, Eser P, Saner H. Long-term Results of a 12-Week Comprehensive Ambulatory Cardiac Rehabilitation Program. J Cardiopulm Rehabil Prev 2013; 33:84-90. [DOI: 10.1097/hcr.0b013e3182779b88] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O'Keefe JH, Milani RV, Blair SN, Church TS. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 2013; 77:281-92. [PMID: 23328449 DOI: 10.1253/circj.cj-13-0007] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Substantial data have established that higher levels of physical activity (PA), participating in exercise training (ET), and higher overall cardiorespiratory fitness (CRF) provide considerable protection in the primary and secondary prevention of coronary heart disease (CHD). This review surveys data from epidemiological and prospective ET studies supporting the favorable impact of PA, ET, and CRF in primary CHD prevention. Clearly, cardiac rehabilitation and ET (CRET) programs have been underutilized for patients with CHD, particularly considering the effect of CRET on CHD risk factors, including CRF, obesity indices, fat distribution, plasma lipids, inflammation, and psychological distress, as well as overall morbidity and mortality. These data strongly support the routine referral of patients with CHD to CRET programs and that patients should be vigorously encouraged to attend CRET following major CHD events.
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Affiliation(s)
- Damon L Swift
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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Obesity, health status, and 7-year mortality in percutaneous coronary intervention: in search of an explanation for the obesity paradox. Int J Cardiol 2012; 167:1154-8. [PMID: 22475846 DOI: 10.1016/j.ijcard.2012.03.105] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Obesity is a growing health problem and is associated with adverse outcomes in coronary artery disease (CAD). However, recent studies have shown better survival in cardiovascular patients with overweight or obesity, which has been referred to as the "obesity paradox". As there is no clear understanding of the phenomenon, we examined the association between body mass index (BMI) and all-cause mortality in patients treated with percutaneous coronary intervention (PCI) at 7-year follow-up, and the potential role of health status in explaining the obesity paradox. METHODS Consecutive PCI patients (72.5% men; mean age 62.0 ± 11.2 years, range [27-90]years) from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry completed the 36-item short-form health survey (SF-36) to assess health status at baseline. Patients were classified into a normal weight, overweight or obesity group. RESULTS The prevalence of normal weight was 34.7% (354/1019), overweight was seen in 45.9% (468/1019) of patients, and 19.3% (197/1019) was obese. After a median follow-up of 7.0 ± 1.7 years, 163 deaths (16.0%) from any cause were recorded. Cumulative hazard functions differed significantly for the obese and overweight group when compared to the normal weight group (log-rank X(2)=6.59, p<0.05). In multivariable analysis, overweight, but not obesity, remained associated with a lower risk for all-cause mortality (HR=0.60, 95%CI [0.42-0.86], p=0.005). Additionally, after adding the 8 health status SF-36 domains to the multivariate model, the association between overweight and mortality remained unchanged. CONCLUSION In our study population overweight, but not obesity, was associated with a lower risk for 7-year mortality in PCI patients. Health status as measured with the SF-36 did not seem to play a role in explaining the obesity paradox.
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Gradwell E, Raman PR. The Academy of Nutrition and Dietetics National Coverage Determination Formal Request. J Acad Nutr Diet 2012; 112:149-76. [DOI: 10.1016/j.jada.2011.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Indexed: 01/15/2023]
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Lavie CJ, Church TS, Milani RV, Earnest CP. Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation. J Cardiopulm Rehabil Prev 2011; 31:137-45. [PMID: 21427600 DOI: 10.1097/hcr.0b013e3182122827] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Physical activity and exercise training (ET) enhance overall cardiorespiratory fitness (ie, fitness), thus producing many benefits in the primary and secondary prevention of cardiovascular diseases. Substantial evidence also indicates that acute and chronic inflammation is involved in the development and progression of atherosclerosis and major cardiovascular events. The most commonly utilized marker of inflammation is C-reactive protein (CRP). In this review, we discuss the importance of inflammation, especially CRP, as a cardiovascular risk marker by reviewing an abundant cross-sectional and clinical intervention literature providing evidence that physical activity, enhanced fitness, and ET are inversely associated with CRP and that being overweight or obese is directly related with inflammation/CRP. Although we discuss the controversy regarding whether or not ET reduces CRP independent of weight loss, clearly physical activity, improved fitness, and ET are associated with reductions in inflammation and overall cardiovascular risk in both primary and secondary prevention.
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Affiliation(s)
- Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, USA.
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Do antioxidant vitamins ameliorate the beneficial effects of exercise training on insulin sensitivity? J Cardiopulm Rehabil Prev 2011; 31:211-6. [PMID: 21427602 DOI: 10.1097/hcr.0b013e318211e3d8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Exercise training has numerous health benefits, and in patients with type 2 diabetes mellitus and metabolic syndrome, it can improve insulin sensitivity and glucose control. A recent publication suggests that antioxidant vitamins (C and E) block these effects on blood glucose. This investigation was undertaken to determine whether antioxidant vitamins ameliorate the beneficial effects of cardiac rehabilitation and exercise training (CRET) on insulin sensitivity and glucose metabolism in patients with coronary heart disease (CHD). METHODS We assessed CHD risk factors, including clinical indices of glucose metabolism, and evaluated the effects of exercise training in 315 patients with CHD with diabetes mellitus and/or metabolic syndrome before and after a 3-month program of CRET. Patients were divided into 2 groups based on self-reported antioxidant vitamin (vitamins C and E) consumption. RESULTS Both groups, 113 patients (36%) consuming vitamins (Vits group) and 202 patients (64%) who reported no vitamin use (no-Vits group) were statistically similar at baseline. Following CRET, patients improved exercise capacity (10%, P < .0001), fasting blood glucose (-7%, P < .0001), percent body fat (-3%, P = .0001), high-sensitive Creactive protein (-31%, P = .003), and various lipids and behavioral parameters, but there was no significant improvement in glycosylated hemoglobin following formal CRET. Both Vits group and no-Vits group achieved statistically similar improvements in fasting blood glucose, body fat, and other CHD risk factors. CONCLUSIONS Commercially available antioxidant supplements (mean dose of 400 IU of vitamin E and 500 mg of vitamin C) do not ameliorate the health benefits of exercise training, including fasting blood glucose, in CHD patients
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Early phase 2 inpatient rehabilitation after acute coronary syndrome treated with primary percutaneous coronary intervention: short- and long-term effects on blood pressure and metabolic parameters. Am J Phys Med Rehabil 2011; 90:589-98. [PMID: 21273893 DOI: 10.1097/phm.0b013e3182063bec] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the 1-yr follow-up effects of inpatient rehabilitation and its prolongation with an ambulatory training program on blood pressure and metabolic risk factors in patients after an acute coronary syndrome. DESIGN A controlled (n = 20) prospective study was undertaken. The study group consisted of 54 consecutive patients participating in a 3-wk inpatient rehabilitation. Of these, 14 chose to continue the training for 3 mos (CR_In+Amb group) and 40 declined (CR_In group). RESULTS Body mass index increased in the CR_In and control groups. The magnitude of change was greater in controls (2.2 ± 2.14 vs. 0.7 ± 1.70 kg/m; P < 0.05). Waist circumference increased only in the control group, and at 12 mos, it was higher than in the CR_In and CR_In+Amb groups (P < 0.05). Mean systolic and diastolic blood pressure increased in the CR_In (from 121/76 to 130/82 mm Hg; P < 0.01) and control (from 122/74 to 139/87 mm Hg; P < 0.01) groups. At 12 mos, blood pressure in the CR_In group was lower than in the control group but higher than in the CR_In+Amb group (119/77 mm Hg; P < 0.05). Total cholesterol, low-density lipoprotein cholesterol level, and triglyceride level at 12 mos were higher in the control group than in the CR_In and CR_In+Amb groups (P < 0.05). C-reactive protein decreased in the CR_In and CR_In+Amb groups (P < 0.01). CONCLUSIONS Inpatient rehabilitation was associated with beneficial effects on blood lipids and C-reactive protein in coronary patients and attenuated the rise in blood pressure and adiposity indices observed in nonparticipants. Prolongation of rehabilitation with an ambulatory program improved blood pressure control.
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Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention. Prog Cardiovasc Dis 2011; 53:397-403. [PMID: 21545925 DOI: 10.1016/j.pcad.2011.02.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Substantial evidence indicates that increased levels of physical activity, exercise training, and overall cardiorespiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention. Clearly, cardiac rehabilitation and exercise training (CRET) programs have been greatly underused in patients with CHD. We review the benefits of formal CRET programs on CHD risk factors including exercise capacity, obesity indices, plasma lipids, inflammation, and psychosocial stress as well as overall morbidity and mortality. These data support the fact that patients with CHD, especially after major CHD events, need routine referral to CRET programs; and patients should be vigorously encouraged to attend these valuable programs.
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA 70121, USA.
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Artham SM, Lavie CJ, Milani RV, Ventura HO. Value of weight reduction in patients with cardiovascular disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 12:21-35. [PMID: 20842479 DOI: 10.1007/s11936-009-0056-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OPINION STATEMENT Obesity is an independent risk factor for cardiovascular (CV) disease and contributes markedly to individual CV risk factors, including hypertension, diabetes mellitus, dyslipidemia, and other chronic conditions, such as osteoarthritis, obstructive sleep apnea, and physical deconditioning. Obesity, defined as a body mass index ≥30 kg/m(2), is associated with increased morbidity and mortality, particularly in severely obese patients with a body mass index ≥35 kg/m(2). Physical activity, healthy eating and behavioral modification are three pivotal approaches to treating obesity. Some individuals may benefit from pharmacologic agents to achieve meaningful weight loss. Unfortunately, there are few such agents at present with proven efficacy and safety profiles. In this review, we discuss the obesity epidemic and its detrimental effects on the CV system, and focus on exercise training and on established pharmacologic agents as well as those on the horizon. We conclude by summarizing the surgical therapeutic options available to treat obesity and the evidence supporting the CV benefits of surgery, and discuss the potential adverse effects of both pharmacologic and surgical options.
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Affiliation(s)
- Surya M Artham
- Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
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Manzoni GM, Villa V, Compare A, Castelnuovo G, Nibbio F, Titon AM, Molinari E, Gondoni LA. Short-term effects of a multi-disciplinary cardiac rehabilitation programme on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: a practice-level study. PSYCHOL HEALTH MED 2011; 16:178-89. [PMID: 21328146 DOI: 10.1080/13548506.2010.542167] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Given that many patients referred to cardiac rehabilitation (CR) are obese, diet therapy, exercise training, nutritional and psychological counselling for both obesity and psychological distress should be included as important components in all CR programmes. In this practice-level, observational study we evaluated the short-term within-group effects of a four-week multi-factorial inpatient CR programme specifically addressed to weight loss, fitness improvement and psychological health increase on 176 obese in-patients with coronary heart disease (CHD). Outcome measures were exercise capacity measured with estimated metabolic equivalents (METs), body mass index (BMI) and psychological well-being (PGWBI). Results show statistically significant improvements in all the PGWBI sub-scales and total score, except in general health (p = 0.393). No moderation effects were found for BMI class, age, diabetes and ejection fraction (EF). METs significantly increased by 30.3% (p < 0.001) and BMI decreased by 1.37 points (p < 0.001). Significant correlations were found between BMI and weight reductions with PGWBI anxiety and total score improvements. This multi-disciplinary CR programme including diet therapy, exercise training and psychological counselling provides indication for short-term within-group effectiveness on functional exercise capacity, BMI and PGWBI in a sample of obese in-patients with CHD. However, controlled studies are needed to corroborate the results we found.
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Affiliation(s)
- Gian Mauro Manzoni
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania, Italy.
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Abstract
PURPOSE Reduced lung function, as measured by the forced expiratory volume in 1 second (FEV1) and the forced vital capacity (FVC), is an independent risk factor for increased cardiovascular morbidity and mortality. Cardiac rehabilitation is known to reduce cardiovascular morbidity and mortality. We therefore investigated whether cardiac rehabilitation would lead to an improvement in lung function. METHODS We measured FEV1 and FVC by using spirometry in 49 participants (age = 65 ± 9 years; 38 men and 11 women) before and after participation in a comprehensive cardiac rehabilitation program. RESULTS At baseline, participants were obese with a body mass index (BMI) of 31 ± 6 kg/m, had normal lung function (FEV1 = 89 ± 16% predicted, FVC = 93 ± 14% predicted), and had a peak oxygen uptake (VO2) of 92 ± 21% of predicted. Following cardiac rehabilitation, participants lost weight (ΔBMI = -1.7 ± 4.3%, P = .01) and increased peak VO2 (Δ peak VO2)= 15 ± 17%, P < .0001). There were no statistically significant changes in FEV1 and FVC. However, in the subset of participants with a BMI 30 kg/m or higher (n = 27), there were statistically significant increases in FEV1 (5.1 ± 8.3%, P = .003) and FVC (4.9 ± 9.3%, P = .01), and changes in FEV1 were significantly correlated with changes in BMI (r = -0.58, P = .002). CONCLUSIONS Lung function improves in association with cardiac rehabilitation only in those participants with a baseline bmi 30 kg/m or higher, and these changes are inversely correlated with loss of weight. this finding suggests that obesity partly explains the association between lung function and cardiovascular risk.
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Manzoni GM, Cribbie RA, Villa V, Arpin-Cribbie CA, Gondoni L, Castelnuovo G. Psychological well-being in obese inpatients with ischemic heart disease at entry and at discharge from a four-week cardiac rehabilitation program. Front Psychol 2010; 1:38. [PMID: 21833207 PMCID: PMC3153756 DOI: 10.3389/fpsyg.2010.00038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 07/12/2010] [Indexed: 12/03/2022] Open
Abstract
The purposes of this observational pre-post study were twofold: 1- to evaluate psychological health in obese patients with ischemic heart disease at admission to cardiac rehabilitation (CR) and 2 – to examine the effectiveness of a 4-week CR residential program in improving obese patients’ psychological well-being at discharge from CR. A sample of 177 obese patients completed the Psychological General Well-Being Inventory (PGWBI) at admission to the CR program and at discharge. The equivalence testing method with normative comparisons was used to determine the clinical significance of improvements after having established that baseline mean scores on the PGWBI scales were significantly lower than normal means. Results show that patients scored equally or better than norms on many PGWBI dimensions at admission to CR but scored significantly worse on Global Score, Vitality and Self-control. At discharge, mean scores that were impaired at baseline returned to normal levels at the more conservative equivalence interval. A 4-week CR program was thus effective in improving obese patients’ psychological well-being. The equivalence testing method allowed to establish the clinical significance of such improvement.
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Affiliation(s)
- Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Ospedale San Giuseppe, Verbania, Italy
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The influence of cardiac rehabilitation on inflammation and metabolic syndrome in women with coronary heart disease. J Cardiovasc Nurs 2010; 25:52-60. [PMID: 19935427 DOI: 10.1097/jcn.0b013e3181b7e500] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) and increased inflammatory markers, both predictors of future cardiovascular events, are more prevalent in women with coronary heart disease (CHD). The influence of cardiac rehabilitation (CR) on MetS and inflammatory biomarkers is not well characterized for women. PURPOSE : The purpose of this article was to examine the effects of a 12-week behaviorally enhanced CR exclusively for women compared with traditional CR on components of the MetS and inflammatory markers in women with CHD. METHODS The randomized clinical trial used 2 treatment groups, both receiving a comprehensive 12-week CR program, with 1 group receiving a motivationally enhanced intervention exclusively for women. A subset of 91 women (mean age, 61.6 years) from the parent study provided serum samples to examine the effects of CR on high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and intercellular adhesion molecule-1 (ICAM-1). RESULTS After CR, the total sample of women demonstrated significant reductions in hsCRP (P =.002), IL-6 (P <.001), TNF-alpha (P =.010), and ICAM-1 (P =.016). Women in the gender-tailored CR program significantly improved all biomarker levels compared with baseline (P <.05 for all), whereas those in the traditional group improved only hsCRP (P <.05) and IL-6 (P <.05) levels. The combined study group demonstrated improvements in several components of MetS (triglycerides, waist circumference, and systolic blood pressure) but not in others (high-density lipoprotein cholesterol, fasting glucose, and diastolic blood pressure). CONCLUSION Cardiac rehabilitation promotes greater improvements in inflammatory biomarkers than in components of MetS for women with CHD. Improvements in body composition or weight may not be a precondition for the benefits of exercise because of loss of abdominal fat. Examining components of MetS as continuous variables is recommended to prevent lost information inherent in dichotomization.
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Oreopoulos A, Padwal R, McAlister FA, Ezekowitz J, Sharma AM, Kalantar-Zadeh K, Fonarow GC, Norris CM. Association between obesity and health-related quality of life in patients with coronary artery disease. Int J Obes (Lond) 2010; 34:1434-41. [PMID: 20386551 DOI: 10.1038/ijo.2010.73] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE In patients with coronary artery disease (CAD), obesity is paradoxically associated with better survival (the 'obesity paradox'). Our objective was to determine whether this counterintuitive relationship extends to health-related quality of life (HRQOL) outcomes. DESIGN Cross-sectional observational study. SUBJECTS All adults undergoing coronary angiography residing in Alberta, Canada between January 2003 and March 2006 in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry. METHODS Patients completed self-reported questionnaires 1 year after their index cardiac catheterization, including the Seattle Angina Questionnaire (SAQ) and the EuroQol 5D (EQ-5D Index). Patients were grouped into six body mass index (BMI) categories (underweight, normal, overweight, mild obesity, moderate obesity and severe obesity). An analysis of covariance was used to create risk-adjusted scores. RESULTS A total of 5362 patients were included in the analysis. Obese patients were younger than normal and overweight participants, and had a higher prevalence of depression and cardiovascular risk factors. In the adjusted models, SAQ physical function scores and the EQ Index (representing overall QOL) were significantly reduced in patients with mild, moderate and severe obesity compared with patients with a normal BMI. Patients with severe obesity had both statistically and clinically significant reductions in HRQOL scores. Depressive symptoms accounted for a large proportion in variability of all HRQOL scores. CONCLUSIONS BMI is inversely associated with physical function and overall HRQOL in CAD patients, especially in patients with severe obesity. High body weight is a modifiable risk factor; however, given the apparent obesity paradox in patients with CAD, it is critical that future studies be conducted to fully clarify the relationships between HRQOL and body composition (body fat and lean mass), nutritional state and survival outcomes.
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Affiliation(s)
- A Oreopoulos
- Department of Clinical Epidemiology, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009; 53:1925-32. [PMID: 19460605 DOI: 10.1016/j.jacc.2008.12.068] [Citation(s) in RCA: 1442] [Impact Index Per Article: 96.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/02/2008] [Accepted: 12/09/2008] [Indexed: 12/14/2022]
Abstract
Obesity has reached global epidemic proportions in both adults and children and is associated with numerous comorbidities, including hypertension (HTN), type II diabetes mellitus, dyslipidemia, obstructive sleep apnea and sleep-disordered breathing, certain cancers, and major cardiovascular (CV) diseases. Because of its maladaptive effects on various CV risk factors and its adverse effects on CV structure and function, obesity has a major impact on CV diseases, such as heart failure (HF), coronary heart disease (CHD), sudden cardiac death, and atrial fibrillation, and is associated with reduced overall survival. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese people with established CV disease, including HTN, HF, CHD, and peripheral arterial disease, have a better prognosis compared with nonoverweight/nonobese patients. This review summarizes the adverse effects of obesity on CV disease risk factors and its role in the pathogenesis of various CV diseases, reviews the obesity paradox and potential explanations for these puzzling data, and concludes with a discussion regarding the current state of weight reduction in the prevention and treatment of CV diseases.
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Affiliation(s)
- Carl J Lavie
- Cardiac Rehabilitation, Exercise Laboratories, Ochsner Medical Center, New Orleans, Louisiana 70121-2483, USA.
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Lavie CJ, Thomas RJ, Squires RW, Allison TG, Milani RV. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clin Proc 2009; 84:373-83. [PMID: 19339657 PMCID: PMC2665984 DOI: 10.1016/s0025-6196(11)60548-x] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Substantial data have established a sedentary lifestyle as a major modifiable risk factor for coronary heart disease (CHD). Increased levels of physical activity, exercise training, and overall cardiorespiratory fitness have provided protection in the primary and secondary prevention of CHD. This review surveys data from observational studies supporting the benefits of physical activity, exercise training, and overall cardiorespiratory fitness in primary prevention. Clearly, cardiac rehabilitation/secondary prevention (CRSP) programs have been greatly underused by patients with CHD. We review the benefits of CRSP programs on CHD risk factors, psychological factors, and overall CHD morbidity and mortality. These data support the routine referral of patients with CHD to CRSP programs. Patients should be vigorously encouraged to attend these programs.
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Affiliation(s)
- Carl J Lavie
- Cardiac Rehabilitation and Exercise Laboratories, Ochsner Medical Center, New Orleans, LA 70121-2483, USA.
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Frohlich ED. Obesity: A Central Risk and Cardiovascular Target of the Cardiometabolic Syndrome. ACTA ACUST UNITED AC 2008; 3:147-8. [DOI: 10.1111/j.1559-4572.2008.00007.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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