Lavie C J, Milani R V
Department of Internal Medicine, Ochsner Clinic, New Orleans, La.
Arch Intern Med. 1993 Apr 26;153(8):982-8.
Cardiac rehabilitation and exercise training improve prognosis following major cardiac events, partly by improving coronary risk factors, including plasma lipids. Only limited data are available to define predictors of lipid improvements following aggressive nonpharmacologic therapy with cardiac rehabilitation.
We studied 237 consecutive patients from two institutions who were enrolled in outpatient phase 2 cardiac rehabilitation and exercise programs. By univariable and multivariable analyses, we assessed the impact of numerous clinical variables, including indexes of obesity, age, gender, lipid concentrations, exercise capacity, and psychological factors, on improvements in plasma lipid values with cardiac rehabilitation.
Coronary risk factors improved following cardiac rehabilitation, including levels of low-density lipoprotein cholesterol (-4%; P < .05), high-density lipoprotein cholesterol (7%; P < .0001), and triglycerides (-13%; P < .0001); body mass index (-2%; P < .0001); percentage of body fat (-5%; P < .0001); and exercise capacity (26%; P < .0001). By both univariable and multivariable analyses, corresponding dyslipidemic baseline values were the strongest predictors of improvements in levels of low-density lipoprotein cholesterol (univariable: r = .51, P < .0001; multivariable: t = 8.5, P < .0001), high-density lipoprotein cholesterol (univariable: r = .37, P < .0001; multivariable: t = 6.6, P < .0001), and triglycerides (univariable: r = .36, P < .0001; multivariable: t = 6.8, P < .0001). By multivariable analyses, reductions in body mass index (t = 4.6, P < .0001) and older age (t = 4.0, P < .0001) were strong independent predictors of reduction in triglyceride values following cardiac rehabilitation. However, low baseline triglyceride values were independently associated with improvements in both low-density and high-density lipoprotein cholesterol levels. Using a model incorporating 13 clinical variables, improvements in lipid values with cardiac rehabilitation were only modestly predictable with the variables assessed, accounting for only 30% to 40% of the improvements in lipid values.
(1) Coronary risk factors markedly improved following cardiac rehabilitation and exercise training. (2) Improvements in lipid values are modestly predictable. (3) Those patients with the worst baseline lipid values had the most improvements in lipid values following cardiac rehabilitation. However, patients with combined hyperlipidemia and low levels of high-density lipoprotein cholesterol are likely to require drug treatment.
心脏康复和运动训练可改善重大心脏事件后的预后，部分原因是改善了包括血脂在内的冠状动脉危险因素。目前仅有有限的数据可用于确定积极的心脏康复非药物治疗后血脂改善的预测因素。
我们研究了来自两家机构的237例连续门诊患者，他们参加了第二阶段心脏康复和运动项目。通过单变量和多变量分析，我们评估了众多临床变量的影响，包括肥胖指标、年龄、性别、血脂浓度、运动能力和心理因素，对心脏康复后血浆脂质值改善的影响。
心脏康复后冠状动脉危险因素得到改善，包括低密度脂蛋白胆固醇水平（降低4%；P<.05）、高密度脂蛋白胆固醇水平（升高7%；P<.0001）和甘油三酯水平（降低13%；P<.0001）；体重指数（降低2%；P<.0001）；体脂百分比（降低5%；P<.0001）；以及运动能力（提高26%；P<.0001）。通过单变量和多变量分析，相应的血脂异常基线值是低密度脂蛋白胆固醇水平改善的最强预测因素（单变量：r=.51，P<.0001；多变量：t=8.5，P<.0001）、高密度脂蛋白胆固醇水平改善的最强预测因素（单变量：r=.37，P<.0001；多变量：t=6.6，P<.0001）和甘油三酯水平改善的最强预测因素（单变量：r=.36，P<.0001；多变量：t=6.8，P<.0001）。通过多变量分析，体重指数的降低（t=4.6，P<.0001）和年龄较大（t=4.0，P<.0001）是心脏康复后甘油三酯值降低的强有力独立预测因素。然而，低基线甘油三酯值与低密度和高密度脂蛋白胆固醇水平的改善独立相关。使用包含13个临床变量的模型，心脏康复后脂质值的改善仅能通过评估的变量进行适度预测，仅占脂质值改善的30%至40%。
（1）心脏康复和运动训练后冠状动脉危险因素明显改善。（2）脂质值的改善只能适度预测。（3）那些基线脂质值最差的患者在心脏康复后脂质值改善最大。然而，合并高脂血症和高密度脂蛋白胆固醇水平低的患者可能需要药物治疗。
