Lavie CJ, Milani RV
Arch Intern Med. 2006;166:1878-1883.
Background
Recent data indicate that young patients with coronary artery disease (CAD) have a poor long-term prognosis. Although the benefits of formal cardiac rehabilitation and exercise training programs are well established, most of these data come from middle-aged and older patients.
Methods.
We assessed baseline behavioral data, quality of life, and risk profiles in 635 consecutive patients with CAD before and after cardiac rehabilitation and exercise training and specifically assessed data in 104 young patients (mean +/- SD age, 48 +/- 6 years; range, 22-54 years) compared with 260 elderly patients (mean +/- SD age, 75 +/- 3 years; range, 70-85 years).
Results.
Compared with older patients, young patients had higher body mass indexes (12.2%, P < .001), total cholesterol-high-density lipoprotein ratio (14.6%, P < .01), and triglycerides level (27.2%, P < .01) as well as a lower high-density lipoprotein cholesterol level (-8.8%, P = .045). Young patients also had higher scores for anxiety and hostility (51.5% and 94.4%, respectively; P < .001 for both), a considerably higher prevalence of anxiety (27.9% vs 13.5%; P < .01) and hostility (12.5% vs 4.6%; P < .01) symptoms, and slightly more depression symptoms (23.1% vs 18.8%) compared with elderly patients. After cardiac rehabilitation and exercise training, young patients had improvements in body mass index (-1.7%, P < .01), percentage body fat (-4.4%, P <.001), high-density lipoprotein cholesterol level (10.2%, P < .001), high-sensitivity C-reactive protein level (-33.3%, P < .01), peak oxygen consumption (11.3%, P < .001), resting heart rate (-4.5%, P = .01), and resting systolic pressure (-2.3%, P = .049) and marked improvements in scores for depression (-58.5%), anxiety (-46.0%), hostility (-45.7%), somatization (-33.8%), and quality of life (15.8%) (P < .001 for all). Young patients also had greater than 50% to greater than 80% reductions in the prevalence of anxiety (P < .001), hostility (P < .01), and depression (P < .001).
Conclusion.
These data demonstrate the adverse psychological and CAD risk profiles that are present in young patients with CAD after major CAD events and are consistent with substantial benefit of formal cardiac rehabilitation and exercise training programs in younger adults.
Comment.
This is the latest in a recent series of original research on outpatient cardiac rehabilitation by these authors. The sum of these studies, including this latest one, continues to provide support for the efficacy of cardiac rehabilitation in the secondary prevention of CAD and myocardial infarction. This article examines a group of cardiac rehabilitation patients, highlighting a subgroup with risk profiles that demonstrate a relatively high degree of risk at the time of event, especially with respect to psychological stress, obesity, and dyslipidemia. Participation and completion of the program were associated with significant improvements in many of the outcome variables associated with these risk factors. These data demonstrate that the increasing numbers of young patients with CAD who present and later enter cardiac rehabilitation programs may need increasing attention to both medical and behavioral therapies for preventing subsequent events. Their longer potential life span makes them even more important with respect to the long-term efficacy of secondary prevention programs and, without that, their potential burden on the healthcare system.
JR