Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
Department of Surgery, Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA.
Clin Ther. 2020 Mar;42(3):385-392. doi: 10.1016/j.clinthera.2020.01.014. Epub 2020 Feb 20.
Cardiovascular disease (CVD) in general and myocardial infarction in particular are the leading causes of mortality in men and women globally. Sex differences in CVD recovery exist, with higher rates of mortality, recurrent myocardial infarction, and poor functional outcomes seen in women compared to men with CVD. Physical inactivity has been identified as a crucial modifiable risk factor linked with poor survival and recovery in patients with CVD. Cardiac rehabilitation programs that aim to improve physical inactivity and cardiorespiratory fitness (CRF), a measure of physical fitness in patients with CVD, have gained popularity. The goals of this commentary were to summarize the existing literature on the impact of CRF on survival in patients with CVD, to document the impact of sex on CVD outcomes, and to highlight any gaps in current knowledge. Even minor improvements in CRF have been linked with improved survival, although contemporary data from randomized controlled trials have shown mixed results. Gender differences in cardiac rehabilitation have been well documented, with lower referral, enrollment, and completion rates noted in women compared to men with CVD. However, data on sex differences in CRF with cardiac rehabilitation are scant, mostly indicating lower peak CRF observed in female compared to male patients on completion. It is unclear whether similar thresholds of peak CRF are needed in male and female patients to improve survival after onset of CVD, and whether exercise prescriptions need to be adapted to include additional forms of exercise. CRF is also influenced by age, with a decline in peak exercise capacity with advancing age observed in both sexes, but steeper declines noted in men than women. From this perspective, we review the data intersecting age, sex, and exercise on survival in patients with CVD, as well as the biological mechanisms at play, and we identify areas for future research (Clin Ther. 2020; 42:XXX-XXX) © 2020 Elsevier Inc.
心血管疾病（CVD）一般，特别是心肌梗死，是全球男性和女性死亡的主要原因。CVD 恢复存在性别差异，与 CVD 男性相比，女性的死亡率、复发性心肌梗死和不良功能结局更高。身体活动不足已被确定为与 CVD 患者生存和恢复不良相关的关键可改变危险因素。旨在改善身体活动和心肺适能（CRF）的心脏康复计划，CRF 是 CVD 患者身体适应性的衡量标准，已经广受欢迎。本评论的目的是总结现有关于 CRF 对 CVD 患者生存影响的文献，记录性别对 CVD 结局的影响，并突出当前知识中的空白。即使 CRF 略有改善也与生存改善相关，尽管来自随机对照试验的当代数据显示结果喜忧参半。心脏康复中的性别差异得到了充分记录，与 CVD 男性相比，女性的转诊、入组和完成率较低。然而，关于心脏康复中 CRF 的性别差异的数据很少，主要表明女性患者在完成时观察到的峰值 CRF 低于男性患者。尚不清楚在 CVD 发病后，男性和女性患者是否需要类似的峰值 CRF 阈值来改善生存，以及是否需要调整运动处方以包括其他形式的运动。CRF 还受年龄影响，两性的最大运动能力都随年龄增长而下降，但男性的下降幅度大于女性。从这个角度出发，我们回顾了年龄、性别和运动对 CVD 患者生存的相互影响的数据，以及起作用的生物学机制，并确定了未来研究的领域（Clin Ther. 2020; 42:XXX-XXX）© 2020 Elsevier Inc.
