Warner J G, Brubaker P H, Zhu Y, Morgan T M, Ribisl P M, Miller H S, Herrington D M
Department of Internal Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1045, USA.
Circulation. 1995 Aug 15;92(4):773-7. doi: 10.1161/01.cir.92.4.773.
It is unknown whether the benefits of a cardiac rehabilitation program on HDL cholesterol (HDL-C) are equally achieved in men and women. To study this, we compared changes in HDL-C and other lipids in a large group of men and women participating in a cardiac rehabilitation program for up to 5 years.
We compared changes in HDL-C and other fasting lipids in 553 men and 166 women participating in a cardiac rehabilitation program at baseline and then annually for up to 5 years. Patients exercised 3 days a week at 70% to 85% of their maximum heart rate predetermined by a symptom-limited treadmill test. Aerobic capacity was estimated in metabolic equivalents (METs), and percent body fat was determined by skin-fold measurements. Baseline HDL-C, LDL cholesterol (LDL-C), and total cholesterol were significantly higher in women, whereas the ratio of total cholesterol to HDL-C was lower. Although both men and women showed an increase in HDL-C after 1 year (10% and 7%, respectively), only the women's level continued to increase over 5 years (20% versus 5% for men, P = .03). The sex difference in change in HDL-C remained after adjustment for age and smoking. A nonsignificant trend toward a greater change in HDL-C in women existed after adjustment for baseline percent body fat and estimated METs. The change in the ratio of total cholesterol to HDL-C was also more favorable in women, with a 38% decrease over 5 years compared with a 14% decrease in men (P = .01). Total cholesterol decreased by 20% in women and 8% in men (P = .001), whereas LDL-C dropped by 34% in women and 15% in men (P = .0001). There was no sex difference in change in triglycerides.
Women with heart disease who participate in a cardiac rehabilitation program may achieve greater lipid benefits over longer periods of time than previously demonstrated in men.
心脏康复计划对高密度脂蛋白胆固醇（HDL-C）的益处是否在男性和女性中同样能够实现尚不清楚。为研究这一问题，我们比较了一大组参与长达5年心脏康复计划的男性和女性的HDL-C及其他血脂的变化情况。
我们比较了553名男性和166名女性在参加心脏康复计划基线时以及随后长达5年每年的HDL-C和其他空腹血脂的变化情况。患者每周锻炼3天，运动强度为症状限制平板试验预先确定的最大心率的70%至85%。以代谢当量（METs）估算有氧能力，通过皮褶测量确定体脂百分比。女性的基线HDL-C、低密度脂蛋白胆固醇（LDL-C）和总胆固醇显著更高，而总胆固醇与HDL-C的比值更低。尽管男性和女性在1年后HDL-C均有所增加（分别为10%和7%），但只有女性的水平在5年中持续上升（女性为20%，男性为5%，P = 0.03）。在调整年龄和吸烟因素后，HDL-C变化的性别差异依然存在。在调整基线体脂百分比和估算的METs后，女性HDL-C变化存在更明显但无统计学意义的趋势。总胆固醇与HDL-C比值的变化在女性中也更有利，5年中下降了38%，而男性下降了14%（P = 0.01）。女性总胆固醇下降了20%，男性下降了8%（P = 0.001），而女性LDL-C下降了34%，男性下降了15%（P = 0.0001）。甘油三酯变化不存在性别差异。
参与心脏康复计划的心脏病女性可能比之前在男性中所证明的那样在更长时间内获得更大的血脂益处。
