Long-term (5-year) changes in HDL cholesterol in cardiac rehabilitation patients. Do sex differences exist?
BACKGROUND
It is unknown whether the benefits of a cardiac rehabilitation program on HDL cholesterol (HDL-C) are equally achieved in men and women. To study this, we compared changes in HDL-C and other lipids in a large group of men and women participating in a cardiac rehabilitation program for up to 5 years.


RESULTS
We compared changes in HDL-C and other fasting lipids in 553 men and 166 women participating in a cardiac rehabilitation program at baseline and then annually for up to 5 years. Patients exercised 3 days a week at 70% to 85% of their maximum heart rate predetermined by a symptom-limited treadmill test. Aerobic capacity was estimated in metabolic equivalents (METs), and percent body fat was determined by skin-fold measurements. Baseline HDL-C, LDL cholesterol (LDL-C), and total cholesterol were significantly higher in women, whereas the ratio of total cholesterol to HDL-C was lower. Although both men and women showed an increase in HDL-C after 1 year (10% and 7%, respectively), only the women's level continued to increase over 5 years (20% versus 5% for men, P = .03). The sex difference in change in HDL-C remained after adjustment for age and smoking. A nonsignificant trend toward a greater change in HDL-C in women existed after adjustment for baseline percent body fat and estimated METs. The change in the ratio of total cholesterol to HDL-C was also more favorable in women, with a 38% decrease over 5 years compared with a 14% decrease in men (P = .01). Total cholesterol decreased by 20% in women and 8% in men (P = .001), whereas LDL-C dropped by 34% in women and 15% in men (P = .0001). There was no sex difference in change in triglycerides.


CONCLUSIONS
Women with heart disease who participate in a cardiac rehabilitation program may achieve greater lipid benefits over longer periods of time than previously demonstrated in men.
Warner
J G
JG
Department of Internal Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1045, USA.
Brubaker
P H
PH
Zhu
Y
Y
Morgan
T M
TM
Ribisl
P M
PM
Miller
H S
HS
Herrington
D M
DM
D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D015444:Exercise; D005260:Female; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012727:Sex Characteristics
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL