Sex differences in psychosocial and cardiometabolic health among patients completing cardiac rehabilitation

Abstract

Current programs of cardiac rehabilitation (CR) typically provide a standardized approach to all patients. We examined whether CR would produce similar improvements in psychosocial and cardiometabolic health indicators in women compared with men. The records of patients who completed a 3-month outpatient CR program were examined. We compared health-related quality of life (i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS) scores), anxiety, depression, and cardiometabolic health indicators between women and men completing CR. Of the 591 participants who completed CR, 155 (26.2%) were women and 436 (73.8%) were men. At baseline, women were older (64 ± 9 vs. 62 ± 9 years, p = 0.045), had lower PCS (39.5 ± 8.1 vs. 43.9 ± 7.8 points, p < 0.001), and MCS (46.6 ± 10.8 vs. 49.4 ± 9.8 points, p = 0.003) scores, experienced elevated levels of anxiety (6.4 ± 4.0 vs. 5.2 ± 4.0 points, p = 0.001) and depression (4.7 ± 3.5 vs. 3.6 ± 3.3 points, p = 0.001), and had higher low-density lipoprotein cholesterol (2.1 ± 0.9 vs. 1.7 ± 0.7 mmol/L, p < 0.001) and high-density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.1 ± 0.3 mmol/L, p < 0.001) concentrations when compared with men. Following CR, women showed smaller improvements in percent body mass (+1.1% ± 10.1% vs. −2.1% ± 9.7%, p = 0.002) and PCS scores (3.0 ± 8.1 vs. 6.3 ± 7.5 points, p < 0.001) when compared with men. Considering poorer psychosocial health at baseline and smaller improvements in health-related quality of life in women when compared with men, more specific CR strategies addressing the particular needs of women are required to improve their health status and reduce the risk of secondary cardiac events.

Women’s outcomes following mixed-sex, women-only, and home-based cardiac rehabilitation participation and comparison by sex

“…Consistent with literature [ 49 , 50 ], women did come to CR with a poorer clinical profile than men. Women presented with poorer functional capacity, and had a poorer risk factor profile, but then they do have more to gain.…”

Sex Differences in Cardiac Rehabilitation Outcomes

“…To date, studies investigating sex differences in lipid management during CR have included patients primarily when the AHA/ACC lipid management guidelines recommended an LDL-C target goal of <100 mg/dL using statin therapy (<70 mg/dL for high-risk patients). 77–79 Approximately 50 to 65% of patients met this LDL-C target goal at CR entry, with large cohort studies (n=8929–117 913) reporting that LDL-C decreased by 14 to 35 mg/dL (reductions of ≈15%–36%) following CR 78,79,106 (with smaller cohort studies reporting smaller or no changes in LDL-C 95–97,99,108,109 ). At CR entry, females were less likely to be at the LDL-C target goal compared with males and are reported to have a lower or similar frequency of meeting the LDL-C target goal at CR completion than males.…”

“…103 As attending CR programming is associated with greater medication adherence/compliance (with a CR session dose response relationship present), 104,105 CR attendance may minimize these sex differences in high-intensity statin use. Recently, Lin et al 106 78,79,107 (with smaller cohort studies reporting smaller or no changes in LDL-C [95][96][97]99,108,109 ). At CR entry, females were less likely to be at the LDL-C target goal compared with males and are reported to have a lower or similar frequency of meeting the LDL-C target goal at CR completion than males.…”

The feasibility of implementing high-intensity interval training in cardiac rehabilitation settings: a retrospective analysis

“…A recent women-only HIIT study by Reed et al demonstrated greater clinically meaningful mental health improvements with HIIT when compared to moderate-tovigorous intensity continuous exercise [2]. Further, Terada et al found that women in CR experienced greater reductions in anxiety severity (as assessed by the Hospital Anxiety and Depression Scale) with HIIT (− 1.7 ± 2.7 vs. -0.4 ± 2.8 points, p = 0.036) when compared to men; yet men had larger improvements with moderateto-vigorous intensity continuous exercise [23]. This provides promising evidence for the use of HIIT for women and underscores the importance of formally examining the impact of such programs for cardiac patients.…”