Artham Surya M, Lavie Carl J, Milani Richard V
Ochsner Medical Center, New Orleans, LA 70121-2483, USA.
South Med J. 2008 Mar;101(3):262-7. doi: 10.1097/SMJ.0b013e318164dfa8.
Adverse behavioral profiles, particularly depression and hostility, increase the risk of coronary artery disease (CAD) and affect recovery after CAD events. We sought to determine the effects of outpatient phase II cardiac rehabilitation and exercise training (CRET) programs in CAD patients with high levels of psychological distress.
We studied 500 consecutive patients both before and after phase II CRET programs and compared 109 patients with the highest quintile of psychological distress (HD) with 115 patients with the lowest quintile of psychological distress (LD).
At baseline, patients with HD were younger (P < 0.001), had higher weight (+11%; P < 0.001), body mass indices (BMI) (+9%; P < 0.01), triglycerides (+66%; P < 0.0001), and glycosylated hemoglobin (+9%; P = 0.03), and had higher scores for depression, hostility, anxiety, and somatization (all P < 0.0001), but had lower values for exercise capacity (-15%; P = 0.02), high-density lipoprotein (HDL) cholesterol (-10%; P < 0.01), and total quality of life (QoL) (-26%; P < 0.0001), and all 6 major components of QoL compared with LD. After CRET, patients with HD had significant reductions in weight (-2%; P < 0.01), % fat (-6%; P < 0.001), BMI (-2%, P < 0.01), and scores for anxiety (-49%), depression (-47%), somatization (-34%) and hostility (-38%) (all P < 0.0001), and increases in exercise capacity (+54%; P < 0.0001), HDL cholesterol (+10%; P < 0.0001), and total QoL (+23%; P < 0.0001), and the 6 components of QoL studied. Compared with patients with LD, those with HD had statistically greater improvements in HDL (P = 0.03), triglycerides (P = 0.03), BMI (P = 0.02), as well as all behavioral characteristics and QoL (P < 0.0001), and had similar improvements in all other factors assessed.
These data support the routine assessment of high-risk behavioral characteristics in patients with CAD and demonstrate the marked improvements that occur after phase II CRET programs in CAD patients with high psychological distress.
不良行为模式，尤其是抑郁和敌意，会增加冠状动脉疾病（CAD）的风险，并影响CAD事件后的恢复。我们试图确定门诊心脏康复二期和运动训练（CRET）计划对心理困扰程度高的CAD患者的影响。
我们对500例连续患者在CRET二期计划前后进行了研究，并将心理困扰程度最高的五分之一患者（HD）中的109例与心理困扰程度最低的五分之一患者（LD）中的115例进行了比较。
在基线时，HD患者更年轻（P<0.001），体重更高（+11%；P<0.001），体重指数（BMI）更高（+9%；P<0.01），甘油三酯更高（+66%；P<0.0001），糖化血红蛋白更高（+9%；P=0.03），抑郁、敌意、焦虑和躯体化得分更高（均P<0.0001），但运动能力更低（-15%；P=0.02），高密度脂蛋白（HDL）胆固醇更低（-10%；P<0.01），总体生活质量（QoL）更低（-26%；P<0.0001），与LD患者相比，QoL的所有6个主要组成部分均更低。CRET后，HD患者体重显著下降（-2%；P<0.01），体脂百分比下降（-6%；P<0.001），BMI下降（-2%，P<0.01），焦虑得分下降（-49%），抑郁得分下降（-47%），躯体化得分下降（-34%），敌意得分下降（-38%）（均P<0.0001），运动能力增加（+54%；P<0.0001），HDL胆固醇增加（+10%；P<0.0001），总体QoL增加（+23%；P<0.0001），以及所研究的QoL的6个组成部分。与LD患者相比，HD患者的HDL（P=0.03）、甘油三酯（P=0.03）、BMI（P=0.02）以及所有行为特征和QoL（P<0.0001）在统计学上有更大改善，并且在所有其他评估因素方面有类似改善。
这些数据支持对CAD患者进行高危行为特征的常规评估，并证明了心理困扰程度高的CAD患者在CRET二期计划后有显著改善。
