Efficacy of Lipid-Lowering Therapy during Cardiac Rehabilitation in Patients with Diabetes Mellitus and Coronary Heart Disease

Abstract

Background: Cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) increases adherence to a healthy lifestyle and to secondary preventive medication. A notable example of such medication is lipid-lowering therapy (LLT). LLT during CR improves quality of life and prognosis, and thus is particularly relevant for patients with diabetes mellitus, which is a major risk factor for CHD. Design: A prospective, multicenter registry study with patients from six rehabilitation centers in Germany. Methods: During CR, 1100 patients with a minimum age of 18 years and CHD documented by coronary angiography were included in a LLT registry. Results: In 369 patients (33.9%), diabetes mellitus was diagnosed. Diabetic patients were older (65.5 ± 9.0 vs. 62.2 ± 10.9 years, p < 0.001) than nondiabetic patients and were more likely to be obese (BMI: 30.2 ± 5.2 kg/m2 vs. 27.8 ± 4.2 kg/m2, p < 0.001). Analysis indicated that diabetic patients were more likely to show LDL cholesterol levels below 55 mg/dL than patients without diabetes at the start of CR (Odds Ratio (OR) 1.9; 95% CI 1.3 to 2.9) until 3 months of follow-up (OR 1.9; 95% CI 1.2 to 2.9). During 12 months of follow-up, overall and LDL cholesterol levels decreased within the first 3 months and remained at the lower level thereafter (p < 0.001), irrespective of prevalent diabetes. At the end of the follow-up period, LDL cholesterol did not differ significantly between patients with or without diabetes mellitus (p = 0.413). Conclusion: Within 3 months after CR, total and LDL cholesterol were significantly reduced, irrespective of prevalent diabetes mellitus. In addition, CHD patients with diabetes responded faster to LTT than nondiabetic patients, suggesting that diabetic patients benefit more from LLT treatment during CR.

Cluster Analysis to Distinguish Patients Most Likely to Benefit from Outpatient Cardiac Rehabilitation—A Prospective, Multicenter Study

“…Among nearly 1500 patients after myocardial infarction, Shwaab et al reported that the proportion of patients achieving LDL-C < 70 mg/dL (1.8 mmol/L) or at least 50% reduction of baseline value increased from ~2% at baseline to ~42% at follow-up after a mean of 22 days of comprehensive cardiac rehabilitation [ 23 ]. Among patients with ischemic heart disease, LDL-C concentrations decreased after 3 months of cardiac rehabilitation and remained reduced for up to 12 months [ 24 ]. In patients after myocardial infarction, high-intensity but not moderate-intensity exercise significantly reduced LDL-C and TG [ 25 ].…”

Virgin Coconut Oil: A Dietary Intervention for Dyslipidaemia in Patients with Diabetes Mellitus

“…Treating the interplay of circulating lipids and the risk of CAD and PAD in people with DM is an emerging and important public health issue. Dyslipidaemia therapy has been demonstrated to provide more benefits to people with DM compared with those without DM, as people with DM responded faster [ 8 ].…”