Gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program

Abstract

Background: Cardiac rehabilitation programs reduce cardiovascular events and mortality in ischemic heart disease patients. The aim of this study was to assess gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program regarding adherence to the program, as well as, changes in clinical, laboratory, and echocardiographic parameters. Results: A prospective study that included 30 men and 30 women with stable ischemic heart disease who had been totally revascularized by percutaneous coronary intervention. Patients were enrolled in a 12-week cardiac rehabilitation program. Assessment of demographics, anthropometric measurements, risk factors, and functional capacity was performed. Lipid profile, glycated hemoglobin, and left ventricular ejection fraction were assessed. Assessments were performed at baseline and after completion of the program. Time to enrollment in the program was prolonged for women 39.17 ± 40.49 vs. 19.77 ± 10.26 days (p = 0.014). At baseline, more women were diabetic (p = 0.004), hypertensive (p = 0.02), had a larger waist circumference (p = 0.022), a higher BMI (p = 0.011), and higher HbA1c (p = 0.033). More men were active smokers (p < 0.001). After completion of the program, it was found that men attended 19.1 ± 4.77 (79.6%) sessions compared to 15.7 ± 5.72 (65.4%) sessions for women (p = 0.015). Women had more reduction in diastolic BP − 10.93 ± 8.94 vs. − 5.47 ± 12.57 mmHg (p = 0.058). The magnitude of reduction in resting heart rate was significant in men (p = 0.018) but not in women (p = 0.376). The magnitude of reduction in serum total cholesterol and triglycerides was more in men (p = 0.018 and p = 0.014). Women showed more reduction in HbA1c (p = 0.052). Conclusion: Men are more adherent to cardiac rehabilitation programs. Recruitment of women is significantly delayed. Women have a higher cardiovascular risk burden in the form of prevalence of diabetes, hypertension, and obesity. Completion of a cardiac rehabilitation program causes a reduction in BMI, waist circumference, blood pressure measurements, total cholesterol, triglycerides, LDL-C, HDL-C, HbA1c, and LVEDD with an increase in LVEF in both genders. Men show more reduction in resting HR, total cholesterol, and triglyceride levels while women show more reduction in diastolic BP and HBA1c.

Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery

“…Enrollment in a cardiac rehabilitation program is recommended for all patients with stable coronary artery disease following MI and PCI [ 20 – 22 ]. Benefits of participating in the cardiac rehabilitation program provided at our institution were previously reported and are comparable to well-established programs elsewhere [ 23 , 24 ].…”

Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome

“…Moreover, women low adherence to CR programs is a very important issue that may interfere with the overall functional improvement. It is widely known that men are more adherent to CR programs and that recruitment for women is often significantly delayed [24]. For women, the barriers to CR participation are multiple and complex and possible solutions such as community and home-based physical activity and women-only cardiac rehabilitation should be offered and are actually under evaluation [25].…”

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

“…Eight studies comparing left ventricular ejection fraction in HD patients reported equal improvements between the sexes or no improvements at all after CR [ 28 , 32 , 49 , 50 , 52 , 71 – 73 ] with a single study finding that men improved to a greater degree than women (only 5 weeks of CR) [ 74 ]. While three studies investigating HR at rest showed a greater improvement in men after CR [ 49 , 72 , 75 ], the majority of the articles investigating HR at rest showed no sex difference or no improvement in either sex [ 27 , 28 , 30 , 31 , 39 , 47 , 50 , 57 , 59 , 64 , 71 , 76 – 80 ]. When comparing these opposing groups of papers, there were no striking differences in terms of disease type, CR duration, adherence rates and exercise type between articles.…”

“…Most of the articles in this review discussing LDL cholesterol, LDL: HDL, and total cholesterol: HDL concluded that no sex differences, or no improvements, in the response to CR were found [ 23 – 26 , 29 , 36 , 37 , 41 , 42 , 45 , 47 , 48 , 50 , 52 , 53 , 59 , 68 , 71 , 72 , 75 , 78 , 87 , 88 , 91 ]. However, interestingly 2 recent studies from Jafri et al and Proenca et al found that men improve LDL to a greater degree than women after CR [ 92 , 93 ].…”

“…These were very large retrospective cohort studies of 15,613 and 881 cardiac patients, respectively. While the majority of studies found that no sex differences were evident in the improvement of total cholesterol after CR [ 23 , 24 , 26 , 29 , 36 , 37 , 47 , 48 , 50 , 52 , 53 , 58 , 59 , 68 , 71 , 75 , 88 , 90 , 91 ], El Missiri et al, Casey et al, Ghasghaei et al, and Jafri et al all concluded that men experienced a greater improvement in total cholesterol levels compared to women [ 45 , 72 , 87 , 92 ]. Adherence to the CR program could have played a role since the studies by Casey et al, El Missiri et al, and Jafri et al found that women had lower completion/adherence rates compared to men; however, adherence was not discussed in the study by Ghashghaei et al Participants with higher adherence are likely to experience greater benefit of CR participation.…”