Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.
Department of Cardiology, Skane University Hospital, Malmö, Sweden.
PLoS One. 2020 May 11;15(5):e0232772. doi: 10.1371/journal.pone.0232772. eCollection 2020.
Randomized trials confirm the benefits of exercise-based cardiac rehabilitation on cardiovascular risk factors. Whether exercise-based cardiac rehabilitation provides the same favourable effects in real-life cardiac rehabilitation settings, in the modern era of myocardial infarction treatment, is less well known. We examined the association between attending exercise-based cardiac rehabilitation and improvements in cardiovascular risk factors at one-year post myocardial infarction in patients included in the Swedish heart disease registry, SWEDEHEART.
In this retrospective registry-based cohort study, we included 19 136 patients post myocardial infarction (75% men, 62.8±8.7 years) who were registered in SWEDEHEART between 2011 and 2013. The association between attending exercise-based cardiac rehabilitation (43% participation rate) and changes in cardiovascular risk profile between baseline and one-year follow-up was assessed using multivariable regression analysis adjusting for age, comorbidities and medication.
Attenders more often reported to have stopped smoking (men 64% vs 50%; women 64% vs 53%, p<0.001 for both, only smokers at baseline considered), be more physically active (men 3.9±2.5 vs 3.4±2.7 days/week; women 3.8±2.6 vs 3.0±2.8 days/week, p<0.001 for both) and achieved a slightly larger reduction in triglycerides (men -0.2±0.8 vs -0.1±0.9 mmol/L, p = 0.001; women -0.1±0.6 vs 0.0±0.8 mmol/L, p = 0.01) at one-year compared to non-attenders. Male attenders gained less weight (+0.0±5.7 vs +0.3±5.7 kg, p = 0.01) while female attenders achieved better lipid control (total cholesterol -1.2±1.4 vs -0.9±1.4 mmol/L, p<0.001; low-density lipoprotein -1.2±1.2 vs -0.9 ±1.2 mmol/L, p<0.001) compared to non-attenders.
In an unselected registry cohort of patients post myocardial infarction, compared to non-attenders those attending exercise-based cardiac rehabilitation achieved significantly larger improvements in cardiovascular risk factors at one-year after the acute event.
随机试验证实了基于运动的心脏康复对心血管风险因素的益处。然而，在心肌梗死治疗的现代时代，基于运动的心脏康复在现实生活中的心脏康复环境中是否能提供同样有利的效果，还不太清楚。我们在瑞典心脏病登记处（SWEDEHEART）中，检查了在心肌梗死后一年期间，参加基于运动的心脏康复治疗（参与率为 43%）与心血管风险因素改善之间的关系。
在这项回顾性基于登记的队列研究中，我们纳入了 19136 名在 2011 年至 2013 年期间在 SWEDEHEART 登记的心肌梗死后患者（75%为男性，年龄 62.8±8.7 岁）。使用多变量回归分析，在调整年龄、合并症和药物治疗后，评估参加基于运动的心脏康复（参与率为 43%）与基线和一年随访之间心血管风险特征变化之间的关联。
参加者更常报告戒烟（男性 64%比 50%；女性 64%比 53%，均为 p<0.001，仅考虑基线吸烟者）、更积极运动（男性 3.9±2.5 比 3.4±2.7 天/周；女性 3.8±2.6 比 3.0±2.8 天/周，均为 p<0.001），并且在一年时甘油三酯降低幅度略大（男性-0.2±0.8 比-0.1±0.9 mmol/L，p=0.001；女性-0.1±0.6 比 0.0±0.8 mmol/L，p=0.01）。与非参加者相比，男性参加者体重增加较少（+0.0±5.7 比+0.3±5.7 kg，p=0.01），而女性参加者血脂控制更好（总胆固醇-1.2±1.4 比-0.9±1.4 mmol/L，p<0.001；低密度脂蛋白-1.2±1.2 比-0.9 ±1.2 mmol/L，p<0.001）。
在急性事件后一年，与非参加者相比，参加基于运动的心脏康复治疗的心肌梗死后患者在心血管风险因素方面取得了更大的改善。
