The association of tobacco use and gender to cardiac rehabilitation outcomes: a preliminary investigation

Abstract

Introduction Cardiac rehabilitation (CR) outcomes are measured in terms of cardiovascular disease (CVD) risk factor reductions, and these predict long-term cardiac status. This report examines whether reported tobacco use has differential effects on successful cardiovascular risk factor modification, especially for women who have greater smoking-related CVD consequences than men. Methods A retrospective cohort analysis was conducted on 1138 adults (74% male) with diagnosed CVD who participated in ≥7 weeks of a comprehensive CR program. Eleven CVD risk factors were assessed at CR entry and completion. Tobacco use was assessed by self-report at CR entry. The primary outcomes were attainment of goal levels for each risk factor. Results Fewer current and former tobacco users reached the preset goal for Maximal Exercise Capacity. Fewer women than men reached the preset goal for HDL. Women who were current or former tobacco users were less likely to meet the target goals for Triglycerides and more likely to meet target goals for Total Cholesterol and Non-HDL Cholesterol. Conclusions This preliminary study suggests the importance of identifying the effect of tobacco use and gender on CR outcomes and the need to evaluate modification of key cardiovascular risk factors for subgroups of cardiac patients.

Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence

“…This lack of gains could be a result of a variety of factors, for example, smokers spend fewer minutes exercising per session in CR than non-smokers (Digenio et al, 1992). Regardless of the proximal cause, current smokers are less likely to reach maximal capacity exercise goals at the end of CR (Weinberger et al, 2014) and current smoking is associated with less gain in health-related quality of life (Oldridge et al, 1998). There is also compelling evidence that smoking directly inhibits fitness gains.…”

Sex differences in the physiological responses to cardiac rehabilitation: a systematic review

“…Adherence to the training sessions was higher in men (47%) than in women (40%) 11 t-test Wahlstrom 2023 [ 80 ] Patients with AF n = 64 (28 men, 36 women) Yoga 12 Weeks CR completion: 100% 11 t-test Warner 1995 [ 88 ] Patients were referred after MI, CABG, percutaneous balloon angioplasty, cardiomyopathy, and/or stable angina n = 719 (553 men 166 women) Aerobic 260 Weeks CR completion: 12% 69/553 men, 8% 14/166 women. Adherence was 70% for men and 68% for women 12 t-test and ANCOVA Weinberger 2014 [ 86 ] Patients with PTCA, CABG, MI, valve replacement, CAD, CHF, angina or cardiomyopathy n = 1138 (843 men, 295 women) Not described ≥ 7weeks; average 11 weeks CR completion: 49% Adherence was 11.5 weeks for men and 11.4 weeks for women 12 Other (Logistic regression) Willenheimer 1998 [ 38 ] Patients with HF and ejection fraction < 45% n = 33 (27 men, 6 women) Aerobic 16 Weeks CR completion: 91% Adherence for men was 78% and for 67% women 12 t-test Wise 2012 [ 51 ] Patients with CHF (NYHA level I-III) also diagnosed with CAD, cardiomyopathy, valvular disease, and or/tachycardia n = 232 (172 men, 60 women) Aerobic and Strength 12 Weeks + median of 4 extra weeks CR completion: 100% All patients attended at least 40% of sessions. …”

“…Weinberger et al concluded that HDL cholesterol levels improved more in men compared to women after CR [ 86 ]. However, the type of exercise prescribed during CR intervention was not specified in this study.…”

A Network Analysis of Cardiovascular Risk Factors in Patients With Heart Disease: The Role of Socioeconomic Status and Sex

“…In addition, those who smoke seem to be less likely to enroll to CR and more likely to drop out if they enroll, which could be due to less financial resources and limited education (115). The benefits of smoking cessation may not be as obvious to smokers because of a variety of reasons: for example, smokers show less measurable improvements (e.g., heart rate response) with regard to physical exercise (117) and have a lower likelihood of reaching their fitness goals if they complete CR (118). It is thus suggested that smokers are provided with more attention, information, and additional support, by trying several approaches such as medication or smoking cessation programs (115).…”