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J Am Coll Cardiol, 2004; 43:1056-1061, doi:10.1016/j.jacc.2003.10.041 © 2004 by the American College of Cardiology Foundation |
* Cardiovascular Health Center, Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
Manuscript received July 15, 2003; revised manuscript received September 26, 2003, accepted October 6, 2003.
* Reprint requests and correspondence: Dr. Richard V. Milani, Department of Cardiology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA.
rmilani{at}ochsner.org
Presented in part at the 74th Annual Scientific Sessions of the American Heart Association, Anaheim, California, November 11 to 14, 2001.
OBJECTIVES: This study was designed to assess the effects of three-month formal phase II cardiac rehabilitation and exercise training programs on high-sensitivity C-reactive protein (HSCRP) levels in patients with coronary heart disease (CHD).
BACKGROUND: High-sensitivity C-reactive protein is associated with abdominal adiposity and other CHD risk factors and is a potent independent predictor of CHD events. Although weight reduction and statin therapy reduce HSCRP levels, the independent effects of cardiac rehabilitation programs on HSCRP are not well established.
METHODS: We analyzed plasma levels of HSCRP in 277 patients with CHD (235 consecutive patients before and after formal phase II cardiac rehabilitation and exercise training programs and 42 "control" patients who did not attend cardiac rehabilitation). Additionally, we determined the effects of cardiac rehabilitation on HSCRP independent of statin therapy and weight loss.
RESULTS: Rehabilitation patients improved significantly in body fat, obesity indices, exercise capacity, and other cardiac risk factors. Mean (5.9 ± 7.7 to 3.8 ± 5.8 mg/l; –36%; p < 0.0001) and median levels of HSCRP (–41%; p = 0.002) decreased significantly in the rehabilitation group but not in the control population. Similar significant reductions in HSCRP occurred in the rehabilitation patients regardless of whether they received statin therapy or lost weight.
CONCLUSIONS: Therapeutic lifestyle changes effected through a three-month cardiac rehabilitation program significantly improved numerous cardiac risk factors. Through this holistic approach to secondary prevention, we observed significant reductions in HSCRP levels. These findings identify another clinical modality of reducing HSCRP beyond use of statin drugs and suggest an additional benefit of formal phase II cardiac rehabilitation and exercise training programs.
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