Background:
CAD is the leading cause of death and disability in US. Cardiac rehabilitation (CR) program is an important secondary-prevention intervention to reduce mortality, cardiovascular (CV) events, & disability. At start of CR program, patients undergo extensive risk assessment to guide risk reduction goals. However, the residual risk at CR completion is not well studied. We sought to investigate the residual modifiable risk factors of patients completing CR
Methods:
We retrospectively reviewed our center’s data on consecutive patients between October 2012 and November 2013 who were entered into the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) registry and identified those who completed the CR program. We calculated their residual risk using the newly released ACC/AHA’s ‘Pooled Cohort Equations CV Risk Calculator’ (ACC/AHA risk) and Framingham risk (FR) calculator
Results:
Out of 128 consecutive CR participants, 44 (34%) completed the program. Patient characteristics and risk assessment are summarized in table 1. As per AACVPR risk stratification algorithm, 37 (84%) of patients were intermediate to high risk. Compared to the start, at completion of CR program, there was a significant improvement in 6-minute walk distance (365±107 vs 484± 137, p<0.001), favorable reduction in total cholesterol, LDL-C, non-HDL-C (p<0.001) and metabolic syndrome (p=0.02). At time of completion, calculated 10 year CV risk using ACC/AHA risk calculator was still elevated (14±10%), while 64% of patients had elevated risk≥7.5% (mean 19.3±9%). FR estimation was low (9±4%). The two risk scores showed moderate correlation (Pearson’s r=0.6, p<0.001), but the ACC/AHA risk was significantly higher than the FR estimation (p<0.001). In multivariate linear regression model, waist circumference (WC) at discharge was significant modifiable independent predictor of ASCVD risk, while systolic BP showed a trend towards significance
Conclusion:
Successful completion of CR program is associated with improvement in CV risk profile. However, the residual CV risk remains elevated at time of CR completion and is driven by WC & systolic BP. Elevated WC from central adiposity is the main residual atherogenic CV risk factor post CR completion. Further research on significant WC reduction during CR is needed
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