Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements?

Taylor, R. S., Unal, B., Critchley, J. and Capewel, S. (2006) 'Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements?'. European Journal of Cardiovascular Prevention & Rehabilitation, Vol 13, Issue 3, pp. 369-374.

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Abstract

Background It is unclear how much of the reduction in cardiac mortality in coronary heart disease (CHD) patients with exercise training is the result of direct effects on the heart and coronary vasculature, or to indirect effects, via primary risk factors.
Objective The aim of this article was to quantify the cardiac mortality benefits of exercise-based rehabilitation attributable to risk factor reductions versus the direct effects on the heart and vasculature.
Methods The I M PACT coronary heart disease model was used to examine the reduction in cardiac mortality attributable to changes in risk factors from a meta-analysis of cardiac rehabilitation randomized, controlled trials. Patients were receiving rehabilitation following an acute myocardial infarction, angina pectoris or revascularization. Outcomes considered were primary risk factors (total cholesterol, systolic blood pressure and smoking behaviour) and cardiac mortality.
Results Nineteen exercise-only cardiac rehabilitation trials (including 2984 patients) were identified. Across these trials, exercise training reduced pooled cardiac mortality by 28% (relative risk, 0.72, 95% confidence interval 0.55-0.95), with 30 fewer deaths than in the control group. Applying the CHD model, approximately 17 (58%) of these 30 fewer deaths were attributable to reductions in major cardiovascular risk factors: 7.1 deaths (minimum estimate 6.2, maximum estimate 9.5) attributable to an 18% reduction in smoking prevalence; 5.9 deaths (minimum -0.6, maximum 12.6) to a 0.11 mmol/l reduction in cholesterol, and 4.4 deaths (-1.0 minimum, 6.7 maximum) to a 2.0 mmHg reduction in systolic blood pressure.
Conclusions Approximately half of the 28% reduction in cardiac mortality achieved with exercise-based cardiac rehabilitation may be attributed to reductions in major risk factors, particularly smoking. (c) 2006 The European Society of Cardiology.

Item Type:	Article
Uncontrolled Keywords:	cardiac rehabilitation exercise training decision analytic modelling meta-analysis cardiac risk factors coronary-heart-disease myocardial-infarction controlled trial secondary prevention randomized-trials blood-pressure program intervention metaanalysis morbidity
Subjects:	WG Cardiovascular System > Heart. Heart Diseases > WG 200 General works
Faculty: Department:	Groups (2002 - 2012) > International Health Group
Depositing User:	Martin Chapman
Date Deposited:	03 Mar 2011 13:32
Last Modified:	06 Feb 2018 13:02
URI:	https://archive.lstmed.ac.uk/id/eprint/1608

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