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.
Cardiol J. 2022;29(1):72-79. doi: 10.5603/CJ.a2020.0006. Epub 2020 Feb 10.
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.
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.
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).
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.
心脏康复（CR）与冠心病（CAD）患者的全因死亡率降低密切相关。CR 对葡萄糖耐量受损（IGT）和功能恢复等病理危险因素的影响仍存在争议。本研究旨在确定 CR 是否除了改善身体运动外，对 IGT 和糖尿病 CAD 患者的病理危险因素有积极影响。
从 2014 年 1 月至 2015 年 6 月，连续招募了 171 名参加 3 个月 CR 的患者。主要终点定义为峰值工作量和 VO2-峰值的改善；糖化血红蛋白（HbA1c）降低被视为次要终点。
血糖正常的患者与糖尿病患者相比，峰值工作量显著提高（从 5.75±1.45 增加到 6.65±1.84 METs 与 4.8±0.8 增加到 4.9±1.4 METs，p=0.018）。血糖正常的患者 VO2-峰值也有所提高（VO2-峰值从 19.3±5.3 增加到 22.5±5.9 mL/min/kg，p=0.003），而糖尿病患者仅呈现统计学上的显著趋势（VO2-峰值从 16.9±4.4 增加到 18.0±3.8 mL/min/kg，p<0.056）。与 IGT 患者相比，糖尿病患者在血糖控制方面获益更多（HbA1c 从 7.7±1.0 降低到 7.4±1.1 与 5.6±0.4 降低到 5.9±0.5，p=0.02）。
多学科 CR 方案可改善 CAD 患者的身体功能能力，特别是血糖正常的患者。IGT 患者和糖尿病患者可能从 CR 方案中受益，但需要在更大的研究中明确长期结果。
