CHD patients benefit from exercise training and weight loss
MedWire News: Results show that participation in a cardiac rehabilitation and exercise training (CRET) program by overweight or obese patients with coronary heart disease (CHD) only slightly decreases mortality, but improves various cardiometabolic factors and their quality of life.
“Although obesity is a cardiovascular risk factor in epidemiological studies, an ‘obesity paradox’ exists in which obesity is associated with favorable prognosis among cohorts of cardiac patients,” say Carl Lavie (Ochsner Medical Center, New Orleans, Louisiana, USA) and colleagues.
The team therefore investigated the validity of this paradox by retrospectively studying 529 consecutive patients with CHD (44% percutaneous intervention, 35% bypass surgery, and 30% myocardial infarction) who were assigned to participate in CRET 2 to 6 weeks after hospital discharge. Of these, 393 individuals had a body mass index (BMI) of 25 kg/m2 or more and 136 patients had a lower BMI.
CRET consisted of individual and group counseling from a dietitian, formal exercise instruction, and group exercise and education sessions three times a week for 12 weeks. The patients were also encouraged to do further exercise on their own.
Writing in the American Journal of Medicine, the researchers found that overweight and obese individuals who lost at least 5% of their body weight after participating in CRET had significant reductions in BMI, percent fat, and levels of low-density lipoprotein (LDL) cholesterol, triglycerides, C-reactive protein (CRP), and fasting glucose, of 5%, 8%, 5%, 17%, and 40%, respectively.
In addition, peak oxygen consumption and high-density lipoprotein cholesterol increased by 16% and 10%, respectively, in these individuals and there were marked improvements in behavioral factors and quality-of-life scores.
Those whose lost less than 5% of their body weight had no significant improvements in percent fat or triglycerides, LDL cholesterol, CRP, and fasting glucose levels, however.
Overall, the 3-year mortality rate was not significantly different between the two groups but tended to be slightly lower in overweight/obese individuals who lost more than 5% of their body weight during CRET than in those who lost less weight, at 3.1% versus 5.1%.
Of note, those with a BMI of 25 kg/m2 or more at baseline had significantly lower total mortality rate than those with a lower baseline BMI, at 4.1% versus 13.2%. Participants with high as opposed to low baseline fat also had a lower total mortality rate at study completion, at 3.8% versus 10.6%.
“Although an obesity paradox exists, in that CHD patients with higher BMI or higher percent body fat have lower mortality than those with less obesity, these results support the safety and potential long-term benefits of purposeful weight loss in overweight and obese patients with CHD,” conclude Lavie et al.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
By Helen Albert