Impact of cardiac rehabilitation on coronary risk factors, inflammation, and the metabolic syndrome in obese coronary patients

Obesity is a coronary heart disease (CHD) risk factor and is prevalent in patients with CHD. The authors reviewed data in 235 consecutive patients before and after formal cardiac rehabilitation and exercise training (CRET) programs and analyzed data in 72 lean patients (body mass index [BMI] <25 kg/m(2)) vs 73 obese patients (BMI>or=30 kg/m(2)). At baseline, obese patients were significantly younger (P<.0001); had higher percentage of body fat (P<.0001) and more dyslipidemia, including higher triglycerides (TG; P<.01), lower high-density lipoprotein (HDL) cholesterol (P<.0001), and higher TG/HDL ratio (P<.0001); and had higher prevalence of metabolic syndrome (61% vs 26%; P<.01) compared with lean patients. Following CRET, obese patients had small, but statistically significant, improvements in obesity indices, including weight (P<.01), BMI (P<.01), and percentage of fat (P=.03), and had more significant improvements in peak exercise capacity (P<.001), HDL cholesterol (P<.001), C-reactive protein (P<.01), behavioral characteristics, and quality of life (P<.0001). The prevalence of metabolic syndrome fell (62% to 51%; P=.1). These results support the benefits of CRET to reduce overall risk in obese patients with CHD.     

Particular Utility of Cardiac Rehabilitation in Relation to Age

Considerable evidence indicates that physical activity, exercise training, and cardio-respiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention, including in the elderly population. However, cardiac rehabilitation and exercise training (CRET) programs have been greatly under-utilized in patients with CHD, and this has been especially noted in populations of elderly patients, where CRET services have been covered by Medicare. We reviewed the benefits of formal CRET programs on CHD risk factors, including exercise capacity, indices of obesity, plasma lipids, inflammation, psychosocial stress, as well as overall morbidity and mortality, including recent studies in the elderly. These data support the routine referral of elderly CHD patients to formal CRET programs, and greater efforts are needed to vigorously encourage patients to attend these highly beneficial programs.     

Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation

BACKGROUND: Recent data indicate that young patients with coronary artery disease (CAD) have a poor long-term prognosis. Although the benefits of formal cardiac rehabilitation and exercise training programs are well established, most of these data come from middle-aged and older patients. METHODS: We assessed baseline behavioral data, quality of life, and risk profiles in 635 consecutive patients with CAD before and after cardiac rehabilitation and exercise training, and specifically assessed data in 104 young patients (mean +/- SD age, 48 +/- 6 years; range, 22-54 years) compared with 260 elderly patients (mean +/- SD age, 75 +/- 3 years; range, 70-85 years). RESULTS: Compared with older patients, young patients had higher body mass indexes (12.2%, P<.001), total cholesterol-high-density lipoprotein ratio (14.6%, P<.01), and triglycerides level (27.2%, P<.01), and a lower high-density lipoprotein cholesterol level (-8.8%, P=.045). Young patients also had higher scores for anxiety and hostility (51.5% and 94.4%, respectively; P<.001 for both), a considerably higher prevalence of anxiety (27.9% vs 13.5%; P<.01) and hostility (12.5% vs 4.6%; P<.01) symptoms, and slightly more depression symptoms (23.1% vs 18.8%) compared with elderly patients. Following cardiac rehabilitation and exercise training, young patients had improvements in body mass index (-1.7%, P<.01), percentage body fat (-4.4%, P<.001), high-density lipoprotein cholesterol level (10.2%, P<.001), high-sensitivity C-reactive protein level (-33.3%, P<.01), peak oxygen consumption (11.3%, P<.001), resting heart rate (-4.5%, P=.01), and resting systolic pressure (-2.3%, P=.049), and marked improvements in scores for depression (-58.5%), anxiety (-46.0%), hostility (-45.7%), somatization (-33.8%), and quality of life (15.8%) (P<.001 for all). Young patients also had greater than 50% to greater than 80% reductions in the prevalence of anxiety (P<.001), hostility (P<.01), and depression (P<.001). CONCLUSION: These data demonstrate the adverse psychological and CAD risk profiles that are present in young patients with CAD following major CAD events, and are consistent with substantial benefit of formal cardiac rehabilitation and exercise training programs in younger adults.     

Disparate effects of improving aerobic exercise capacity and quality of life after cardiac rehabilitation in young and elderly coronary patients

PURPOSE: Although cardiopulmonary exercise variables predict prognosis, functional capacity, and quality of life (QoL) in patients with coronary artery disease (CAD), these variables have not been assessed fully before and after exercise training in elderly with CAD. Therefore, the purpose of this study was to determine the impact of formal Phase II cardiac rehabilitation and exercise training programs on cardiopulmonary variables and QoL in elderly and younger CAD patients. METHODS: The authors analyzed consecutive patients before and after Phase II cardiac rehabilitation and exercise training programs, and compared exercise cardiopulmonary data and data from validated questionnaires assessing QoL (MOS SF-36) and function in 125 younger patients (< 55 years; mean 48 +/- 6 years) and 57 elderly (> 70 years; mean 78 +/- 3 years). RESULTS: At baseline, elderly patients had lower estimated aerobic exercise capacity (-27%; P < 0.001), peak oxygen consumption (VO2) (-19%; P < 0.01), and anaerobic threshold (-10%; P < 0.05), as well as total function scores (-11%; P < 0.01) and total QoL scores (-5%; P = 0.06). Commonly used prediction equations greatly overestimated aerobic exercise capacity compared with precise measurements using cardiopulmonary testing both before (+23% and +12% in younger and elderly patients, respectively) and after the exercise training programs (+51% and +31% in younger and elderly patients, respectively), and more so in younger compared with older patients. After rehabilitation, the elderly had significant improvements in estimated aerobic exercise capacity (+32%; P < 0.0001), peak VO2 (+13%; P < 0.0001), anaerobic threshold (+11%; P = 0.03), total function scores (+27%; P < 0.0001), and total QoL scores (+20%; P < 0.0001). Although younger patients had greater improvements in estimated aerobic exercise capacity (+44% versus +32%; P = 0.08), peak VO2 (+18% versus +13%; P < 0.01), and anaerobic threshold (+17% versus +11%; P = 0.07), the elderly had statistically greater improvements in both function scores (+27% versus +20%; P = 0.02), and total QoL scores (+20% versus +14%; P = 0.03). CONCLUSIONS: These data confirm the benefits of precisely determining aerobic exercise capacity by cardiopulmonary function, especially to determine the benefits of an exercise training program. In addition, these data using cardiopulmonary exercise tests and validated assessments of quality of life demonstrate the disparate effects of cardiac rehabilitation programs on improvements in aerobic exercise capacity and QoL in young and elderly with CAD.     

Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention

Substantial evidence indicates that increased levels of physical activity, exercise training, and overall cardiorespiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention. Clearly, cardiac rehabilitation and exercise training (CRET) programs have been greatly underused in patients with CHD. We review the benefits of formal CRET programs on CHD risk factors including exercise capacity, obesity indices, plasma lipids, inflammation, and psychosocial stress as well as overall morbidity and mortality. These data support the fact that patients with CHD, especially after major CHD events, need routine referral to CRET programs; and patients should be vigorously encouraged to attend these valuable programs.     

Coronary risk profiles in men with coronary artery disease: effects of body composition, fat distribution, age and fitness

BACKGROUND: Few studies have investigated the influence of body composition, abdominal obesity, age and fitness on coronary risk factors in populations of patients with coronary heart disease (CHD). We investigated whether abdominal obesity or generalized adiposity is a better predictor of cardiovascular risk in men with coronary artery disease (CAD), and the effects of exercise training on coronary risk factors in younger and older patients with CAD. METHODS: The study population consisted of 81 male patients aged 33-83 years (mean +/- SD 60.0 +/- 13.3 years) with established CAD. We studied the relationships among body composition, body fat distribution, dietary intake, peak aerobic capacity, lipid concentrations, and plasma glucose and insulin concentrations. We subsequently measured the influence of exercise training on these components. RESULTS: The study population was characterized by a high prevalence of obesity, particularly in younger patients. Body mass index, rather than body fat distribution, was the best anthropometric predictor of plasma triglyceride concentrations (r2 = 0.11, P < 0.05) and cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio (r2 = 0.13, P < 0.01). Body weight, rather than body fat distribution, was the best predictor of plasma HDL-C concentration (r2 = 0.14, P < 0.01) and fasting glucose concentrations (r2 = 0.10, P < 0.05). Fat mass was the best anthropometric predictor of fasting plasma insulin concentrations (r2 = 0.38, P < 0.0001) and for the glucose-insulin ratio (r2 = 0.39, P < 0.0001) in men with CAD. Younger patients tended to have greater improvements in HDL-C concentrations and the cholesterol:HDL-C ratio than did older individuals, as a result of exercise training. CONCLUSION: In men with CAD, general measures of obesity, such as body weight, body mass index, and fat mass are better predictors of coronary risk factors than body fat distribution. Younger and older men with CAD experienced similar improvements in body composition and body fat distribution after an exercise training program.     

Benefits of Cardiac Rehabilitation and Exercise Training Programs in Elderly Coronary Patients

The authors review several studies from the Ochsner Heart and Vascular Institute showing the benefits of formal phase II cardiac rehabilitation and exercise training programs in elderly patients with coronary artery disease, including benefits on plasma lipids, obesity indices, exercise capacity, peak oxygen consumption, behavioral characteristics (especially depression), and quality of life. Marked benefits were noted in elderly women and all elderly patients over the age of 75 years. The authors conclude that the therapy has proved to be safe and effective for elderly coronary patients, and that these individuals should be routinely referred to, and vigorously encouraged to attend, cardiac rehabilitation programs following major coronary events.     

Cardiac rehabilitation and exercise therapy in the elderly: Should we invest in the aged?

Coronary heart disease (CHD) is the leading cause of death worldwide and becomes increasingly prevalent among patients aged 65 years and older. Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event, especially compared to their younger counterparts. The last few decades were privy to multiple studies that demonstrated the beneficial effects of cardiac rehabilitation (CR) and exercise therapy on mortality, exercise capacity, psychological risk factors, inflammation, and obesity among patients with CHD. Unfortunately, a significant portion of the available data in this field pertains to younger patients. A viable explanation is that older patients are grossly underrepresented in these programs for multiple reasons starting with the patient and extending to the physician. In this article, we will review the benefits of CR programs among the elderly, as well as some of the barriers that hinder their participation.     

Primary cardiovascular events and serum lipid levels in elderly Japanese with hypercholesterolemia undergoing 6-year simvastatin treatment: a subanalysis of the Japan lipid intervention trial

OBJECTIVES: To determine the relationship between serum lipid levels and the incidence of coronary events in older Japanese hypercholesterolemic patients without prior coronary heart disease (CHD). DESIGN: Post hoc subanalysis of the results in the Japan Lipid Intervention Trial. SETTING: A large-scale cohort observational study conducted throughout Japan. PARTICIPANTS: Men aged 35 to 70 and postmenopausal women younger than 70 with serum total cholesterol (TC) level of 220 mg/dL or greater treated for 6 years with low-dose simvastatin (52,421 total patients). After exclusion of 5,127 patients because of prior CHD and 4,934 patients because of incomplete data, 42,360 patients were divided into an older (9,860 patients, aged 65-70, mean age 67.1) and younger (32,500 patients, younger than 65, mean age 54.9) group and analyzed. MEASUREMENTS: Fasting serum lipid levels were measured every 6 months. Major coronary events, including fatal or nonfatal myocardial infarction, and sudden cardiac death as the primary endpoint and other cardiovascular diseases, including onset of angina pectoris, cerebrovascular events, and any causes of death, as the secondary endpoints were monitored. RESULTS: Simvastatin treatment in older patients was as safe and effective as in younger patients. Incident rates of major coronary events were 1.30 per 1,000 patient-years in the older group and 0.80 per 1,000 patient-years in the younger group. The incidence of a major coronary event was correlated to serum TC and low-density lipoprotein cholesterol (LDL-C) levels in both groups. The absolute risk of major coronary events in the older group was higher than in the younger group at any level of LDL-C, whereas the relative risk increased by 1.7% with an elevation of each 1 mg/dL LDL-C level in both groups. In the older group, the risk of major coronary events also increased as triglyceride level increased, whereas the risk decreased as high-density lipoprotein cholesterol level increased above 60 md/dL. CONCLUSION: The LDL-C level-dependent increase of relative risk of CHD was similar in elderly and younger patients, whereas the absolute risk at any LDL-C level in elderly patients was higher than in younger patients.     

Low HDL-C: a secondary target of dyslipidemia therapy

Current guidelines for the prevention of coronary heart disease (CHD) focus on lowering low-density lipoprotein cholesterol (LDL-C) as the primary target of lipid-modifying therapy. However, there is increasing interest in high-density lipoprotein cholesterol (HDL-C) as a secondary target of therapy. A wealth of epidemiologic data demonstrate that low levels of HDL-C are associated with an increased risk of CHD events, and data from large-scale clinical trials with statins and fibrates indicate that observed clinical benefits are related, at least in part, to improvements in HDL-C levels. Raising HDL-C levels with therapeutic lifestyle changes and pharmacologic intervention might afford opportunities to further reduce the risk of CHD beyond LDL-C lowering. Statins are first-line pharmacotherapy for dyslipidemia and can also improve HDL-C levels, although the extent to which they modify HDL-C varies. Combining a fibrate or niacin with statin therapy raises HDL-C more than a statin alone but might be associated with reduced tolerability and increased adverse reactions. Several new therapeutic approaches to raising HDL-C are in development, including an HDL mimetic and inhibitors of cholesteryl ester transfer protein. Although lowering LDL-C remains the primary target of lipid-modifying therapy, dyslipidemia therapies that are efficacious for both LDL-C reduction and raising HDL-C might offer further improvements in CHD risk reduction.     

Distribution of lipid phenotypes in community-living men with coronary heart disease. High prevalence of isolated low levels of high-density lipoprotein cholesterol.

BACKGROUND--Risk factor modification, including treatment of dyslipidemias, has been recommended for the prevention of future coronary events in patients with coronary heart disease (CHD). Since the prevalence of various dyslipidemias among outpatients with CHD has not been well documented, the purpose of this study was to determine the frequency of specific lipid phenotypes among ambulatory men with CHD. METHODS--Lipid profiles were obtained in 255 men (mean age, 65.5 +/- 9.1 years) with CHD in three Veterans Affairs medical centers. Desirable levels of lipids were defined according to National Cholesterol Education Program guidelines as follows: low-density lipoprotein cholesterol (LDL-C) levels less than 3.36 mmol/L (130 mg/dL); high-density lipoprotein cholesterol (HDL-C) levels equal to or greater than 0.90 mmol/L (35 mg/dL); and triglyceride levels less than 2.83 mmol/L. RESULTS--Seventy-six percent of the group had one or more abnormalities on lipid profile: 51% had high LDL-C levels with or without abnormalities of HDL-C and/or triglyceride levels; 22% had low HDL-C levels with desirable levels of LDL-C; and 3% had hypertriglyceridemia without any cholesterol abnormalities. Normal lipid profiles were significantly more prevalent in subjects over the age of 65 years than in younger patients (40% vs 14%). CONCLUSIONS--These data suggest that (1) a high proportion of men with CHD have dyslipidemia, including 50% with LDL-C level elevations. For these men, the potential benefits of therapeutic intervention have been documented in clinical trials, although the cost-efficiency of wide-scale treatment has not been determined; (2) isolated hypertriglyceridemia is rare in this population; and (3) low HDL-C levels in association with desirable LDL-C levels are present in more than one fifth of male patients with CHD. Clinical trials focusing on this large group are urgently needed to determine whether efforts to raise HDL-C levels result in reduced cardiac morbidity and/or mortality.     

老年冠心病患者抑郁与血脂水平的关系

目的:探讨老年冠心病患者抑郁与血脂水平之间的关系。方法:采用病例对照研究方法,将老年冠心病患者168例按抑郁自评量表(SDS)及综合医院焦虑抑郁量表抑郁分表(HAD)评分分为冠心病伴抑郁组(抑郁组,87例)和冠心病不伴抑郁组(非抑郁组,81例)。测定所有研究对象的血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白α(Lp(α))。结果:抑郁组TG、LDL-C水平显著高于非抑郁组(P0.01),而TC显著低于非抑郁组(P0.01)。多元逐步回归分析,TC、TG、LDL-C是抑郁的影响因素。结论:血脂的变化与抑郁情绪有关,伴有抑郁情绪的冠心病患者血脂异常更为明显。     

Reduction in C-reactive protein through cardiac rehabilitation and exercise training

OBJECTIVES: This study was designed to assess the effects of three-month formal phase II cardiac rehabilitation and exercise training programs on high-sensitivity C-reactive protein (HSCRP) levels in patients with coronary heart disease (CHD). BACKGROUND: High-sensitivity C-reactive protein is associated with abdominal adiposity and other CHD risk factors and is a potent independent predictor of CHD events. Although weight reduction and statin therapy reduce HSCRP levels, the independent effects of cardiac rehabilitation programs on HSCRP are not well established. METHODS: We analyzed plasma levels of HSCRP in 277 patients with CHD (235 consecutive patients before and after formal phase II cardiac rehabilitation and exercise training programs and 42 "control" patients who did not attend cardiac rehabilitation). Additionally, we determined the effects of cardiac rehabilitation on HSCRP independent of statin therapy and weight loss. RESULTS: Rehabilitation patients improved significantly in body fat, obesity indices, exercise capacity, and other cardiac risk factors. Mean (5.9 +/- 7.7 to 3.8 +/- 5.8 mg/l; -36%; p < 0.0001) and median levels of HSCRP (-41%; p = 0.002) decreased significantly in the rehabilitation group but not in the control population. Similar significant reductions in HSCRP occurred in the rehabilitation patients regardless of whether they received statin therapy or lost weight. CONCLUSIONS: Therapeutic lifestyle changes effected through a three-month cardiac rehabilitation program significantly improved numerous cardiac risk factors. Through this holistic approach to secondary prevention, we observed significant reductions in HSCRP levels. These findings identify another clinical modality of reducing HSCRP beyond use of statin drugs and suggest an additional benefit of formal phase II cardiac rehabilitation and exercise training programs.     

低密度与高密度脂蛋白胆固醇比值对冠心病的诊断价值

目的 探讨低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)浓度的比值与冠心病(CHD)的相关性。方法 对68例胸痛患者行冠状动脉造影,并同时测定其血脂成分。结果CHD组总胆固醇(TC)、血清甘油三酯(TG)、LDL-C、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C高于对照组,HDL-C(低于对照组。LDL-C/HDL-C与CHD的相关性最强(OR=3.79,OR95％Cl=1.88-6.14)。结论 CHD患者存在多种血脂异常,LDL-C/HDL-C是一项有较好使用价值的CHD预测指标。     

血清胆红素和血脂的综合指数与冠心病的关系研究

目的探讨血清胆红素与血脂的综合指数与冠心病(CHD)的关系.方法将80名行冠状动脉造影术的患者分为2组:CHD组与对照组(冠状动脉正常).测定血清总胆红素水平(TBIL),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),计算出其综合指数:LDL-C/(HDL-C TBIL)和TC/(HDL-C TBIL),分析其与CHD之间的关系.结果CHD患者血清TBIL水平明显低于非冠心病患者(P＜0.05).CHD患者总胆固醇(TC),低密度脂蛋白胆固醇(LDL-C),LDL-C/(HDL-C TBIL)比值,TC/(HDL-C TBIL)比值水平明显高于冠状动脉正常组(P＜0.05).进行Logistic回归分析,TC,LDL-C,LDL-C/(HDL-C TBIL),TC/(HDL-C TBIL)可引入Logistic回归模型,它们为CHD的危险因素.结论CHD的发生与TBIL的降低有一定的相关性,综合考虑血脂、血清胆红素与血脂的综合指数有助于CHD的诊断.     

Cardiac rehabilitation in older patients: Indication or limitation?

ObjectiveTo assess the clinical impact of a cardiac rehabilitation program in an older population.MethodsThis is a retrospective analysis of 731 coronary patients who attended phase 2 of a cardiac rehabilitation program between January 2009 and December 2016. We compared the response to the program of older (≥65 years) and younger (<65 years) patients, analyzing changes in metabolic profile (including body mass index, waist circumference and lipid profile), exercise capacity, cardiac autonomic regulation parameters (such as chronotropic index and resting heart rate), and health-related quality of life scores.ResultsOlder patients represented 15.9% of our cohort. They showed significant reductions in waist circumference (male patients: 98.0±7.9 cm vs. 95.9±7.9 cm, p<0.001; female patients: 90.5±11.4 cm vs. 87.2±11.7 cm, p<0.001), LDL cholesterol (102.5 [86.3-128.0] mg/dl vs. 65.0 [55.0-86.0] mg/dl, p<0.001) and triglycerides (115.0 [87.8-148.5] mg/dl vs. 97.0 [81.8-130.0] mg/dl, p<0.001). Post-training data also showed a noticeable improvement in older patients’ exercise capacity (7.6±1.8 METs vs. 9.3±1.8 METs, p<0.001), along with a higher chronotropic index and lower resting heart rate. Additionally, health-related quality of life indices improved in older subjects. However, our overall analysis found no significant differences between the groups in changes of the studied parameters.ConclusionOlder coronary patients benefit from cardiac rehabilitation interventions, similarly to their younger counterparts. Greater involvement of elderly patients in cardiac rehabilitation is needed to fully realize the therapeutic and secondary preventive potential of such programs.     

Beneficial effect on blood pressure and lipid profile by programmed exercise training in Taiwanese patients with mild hypertension

Mild essential hypertensive patients comprise a large portion of the hypertensive population. Previous reports have shown that moderate-intensity regular exercise training in these patients usually reduces blood pressure. By designing programmed exercise to evaluate whether it is effective in reducing blood pressure in mild hypertensive patients and also has beneficial effects on other biochemical parameters. Twenty-three mild hypertensive Taiwanese patients (resting blood pressure 139.1 +/- 11.4/99.5 +/- 8.0 mmHg) were divided randomly into two groups: control (no exercise) and moderate-intensity exercise (average 6.4 +/- 0.7 METs). The training group exercised three times per week at the prescribed exercise intensity by using the Treadmill exercise test. Blood pressure, heart rate and other biochemical parameters were monitored regularly every 4 weeks for 12 weeks. After 12 weeks regular exercise training, the exercise group showed for significant resting blood pressure reduction. Mean maximal reduction of systolic pressure was 18 mmHg. Significant reduction of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglyceride were found; elevation of high-density lipoprotein cholesterol (HDL-C) was also noted. These data suggest that after 12 weeks of exercise training in mild hypertensive patients, successful reduction of blood pressure and favorable changes of lipid profile will be noted.     

Clinical profile and outcomes of obese patients in cardiac rehabilitation stratified according to National Heart, Lung, and Blood Institute criteria

PURPOSE: Obesity is a major health problem and must be evaluated and treated in cardiac rehabilitation patients. The purpose of this study was to identify the scope of this problem in an urban-based cardiac rehabilitation program by evaluating the prevalence of obesity, and comparing the clinical and risk factor profiles and outcomes of patients stratified according to National Heart, Lung, and Blood Institute (NHLBI) weight classifications. METHODS: Four hundred forty-nine consecutive cardiac rehabilitation patients, aged 57 +/- 11 years, were stratified according to the NHLBI criteria as: normal (body mass index [BMI] 18-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), class I/II obese (BMI 30-39.9 kg/m2), and class III morbidly obese (BMI > or = 40 kg/m2). Baseline cardiac risk factors and dietary habits were identified, and both pre- and postexercise training measurements of exercise tolerance, weight, and lipid profile were obtained. RESULTS: Overweight and obesity (BMI > or = 25 kg/m2) were present in 88% of patients. Compared to normal weight patients, obese patients were younger and had a greater adverse risk profile (higher prevalence of diabetes and hypertension, larger waist circumference, lower exercise capacity, lower high-density lipoprotein cholesterol level) at entry. After 10 weeks, all groups had a significant increase in exercise capacity, and on average obese patients in each category lost weight (Class I/II--4 lbs and Class III--12 lbs). Dropout rates were similar among the groups. CONCLUSION: Overweight and obesity are highly prevalent in cardiac rehabilitation. Overweight and obese patients had a greater adverse cardiovascular risk profile, including a lower exercise capacity in the latter. Thus, targeted interventions toward weight management in contemporary cardiac rehabilitation programs are important. Although short-term outcomes appear promising, greater efforts to improve these outcomes and to support long-term management are needed.     

老年冠心病患者不同临床类型血脂水平的观察

目的　探讨老年冠心病患者不同临床类型血脂水平的差异。方法　将确诊为冠心病的 70岁以上老年患者6 4 7例 ,分为急性心肌梗死 (AMI)组、稳定性心绞痛 (SAP)组、不稳定性心绞痛 (UAP)组 ,另选无冠心病的老年患者 70例作为对照组 ,比较各组间的血脂水平。结果　AMI组和UAP组血清胆固醇水平与对照组及SAP组比较 ,差异有显著性意义 ;血清甘油三酯水平随着冠心病病情程度加重 ,呈逐渐升高的趋势 ;SAP组、UAP组和AMI组低密度脂蛋白胆固醇 (LDL C)水平高于对照组 ,高密度脂蛋白胆固醇 (HDL C)水平低于对照组 ,差异有显著性意义 ;SAP组、UAP组和AMI组LDL C HDL C比值均高于对照组 ,AMI组LDL C HDL C比值高于UAP组和SAP组 ,差异有显著性意义。结论　在 70岁以上老年冠心病患者中 ,LDL C HDL C比值与AMI的发生关系密切     

BENEFICIAL EFFECT ON BLOOD PRESSURE AND LIPID PROFILE BY PROGRAMMED EXERCISE TRAINING IN TAIWANESE PATIENTS WITH MILD HYPERTENSION

Mild essential hypertensive patients comprise a large portion of the hypertensive population. Previous reports have shown that moderate-intensity regular exercise training in these patients usually reduces blood pressure. By designing programmed exercise to evaluate whether it is effective in reducing blood pressure in mild hypertensive patients and also has beneficial effects on other biochemical parameters. Twenty-three mild hypertensive Taiwanese patients (resting blood pressure 139.1±11.4/99.5±8.0?mmHg) were divided randomly into two groups: control (no exercise) and moderate-intensity exercise (average 6.4±0.7?METs). The training group exercised three times per week at the prescribed exercise intensity by using the Treadmill exercise test. Blood pressure, heart rate and other biochemical parameters were monitored regularly every 4 weeks for 12 weeks. After 12 weeks regular exercise training, the exercise group showed for significant resting blood pressure reduction. Mean maximal reduction of systolic pressure was 18?mmHg. Significant reduction of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglyceride were found; elevation of high-density lipoprotein cholesterol (HDL-C) was also noted. These data suggest that after 12 weeks of exercise training in mild hypertensive patients, successful reduction of blood pressure and favorable changes of lipid profile will be noted.