Philip. A. Ades

PURPOSE: Coronary artery bypass graft (CABG) surgery patients participating in cardiac rehabilitation (CR) experience improvements in aerobic fitness, but there has been little study of outcomes for heart valve (HV) surgical patients. The primary aims of this study were to evaluate baseline peak aerobic capacity for HV patients participating in CR and to compare outcomes between HV and CABG patients. METHODS: Five hundred seventy-six consecutive patients who underwent HV surgery (n = 125), HV plus CABG surgery (n = 57), or CABG surgery (n = 394), all with classic sternotomy and enrolled in CR, were prospectively studied. Changes in outcomes were assessed for individuals who completed CR (n = 313). RESULTS: HV patients were significantly older and had a greater percentage of females than the CABG-only group. Combining HV and HV + CABG groups, valvular disorders included 134 mitral, 39 aortic, and 8 combined abnormalities (mitral and aortic). For the entire cohort, the mean number of CR exercise sessions attended was 23.6 ± 11.7. Peak oxygen uptake ( ) increased 19.5% from 17.4 ± 4.4 to 20.8 ± 5.5 mLO₂·kg⁻¹·min⁻¹ (P < .0001). Improvement in peak with CR exercise training was similar between the 3 groups of patients. Within the group of patients who had HV surgery, percentage change in peak was not significantly different between the 3 types of valvular abnormalities (ie, mitral [19.2%], aortic [24.4%], and mitral + aortic [21.9%]). CONCLUSIONS: HV surgery patients achieve similar improvement in aerobic fitness from participating in CR exercise training as individuals who had CABG. The observed improvements in aerobic fitness are similar, regardless of the type of valve abnormality or whether CABG was performed concurrently.

PURPOSE: To determine the rate of remission of recently diagnosed (2), sedentary, and unfit ( O_2peak = 20.7 ± 4.7 mL·kg⁻¹·min⁻¹) and recently (P < .001). CONCLUSIONS: For individuals with recently diagnosed T2DM willing to undertake a formal lifestyle program, 80% of study completers and 67% of our total population achieved at least a partial T2DM remission at 6 months. Further study of this intervention at the time of diagnosis of T2DM with randomized controls and longer-term followup is warranted.

The 2013 ACC/AHA guidelines on the treatment of blood cholesterol in adults is a major step forward in the field of preventive cardiology but it is not without controversy. It should be well accepted that in individuals with established atherosclerotic vascular disease, individuals with a low-density lipoprotein cholesterol of greater than 190 mg/dl and individuals with diabetes, treatment with an appropriate fixed dose of a statin, without titration to a specific low-density lipoprotein goal, will provide substantial protection against future atherosclerotic vascular disease events. More controversial is the utilization of a risk calculator in primary care to determine which individuals will require a statin. For as long as these risk calculators are in question, primary care practitioners will struggle to make treatment decisions. Factors such as cardiovascular fitness, measures of adiposity, and details of the family history will aid in treatment decisions.

INTRODUCTION: Overweight is highly prevalent among cardiac rehabilitation (CR) participants. The purpose of this study was to assess the course of body weight change after an acute coronary event, from hospitalization through completion of CR. METHODS: Body weight was measured inhospital at the time of admission for the index cardiac event (hospitalization), at CR entry, and at exit from CR. RESULTS: The study population consisted of 181 patients who entered into outpatient CR and completed up to 36 sessions. The average age, weight, and body mass index at baseline were 65.2 ± 10.9 years, 85.2 ± 16.2 kg, and 29.6 ± 4.4, respectively. Body weight decreased from hospitalization to CR entry (2.5 ± 3.0 kg) and from CR entry to CR exit (2.4 ± 4.3 kg) (P < .86). The mean total weight loss from hospitalization to CR exit was 4.8 ± 4.8 kg. Forty-nine overweight individuals attended 4 behavioral weight loss sessions during CR. Compared with participants who did not, behavioral weight loss classes attendees lost more weight from hospital admission to CR exit (8.1 ± 4.4 vs 3.6 ± 4.4 kg) and during CR (5.6 ± 4.1 vs 1.2 ± 3.8 kg) (both, P < .0001). CONCLUSIONS: Cardiac patients lose significant weight between hospitalization and CR entry. Nearly half of the total weight loss that patients experienced from hospitalization to CR exit occurred prior to CR entry. Overall, overweight individuals lose nearly 5 kg or 6% of their weight. Our results suggest that a behavioral weight loss intervention delivered through CR helps sustain weight loss observed during the early convalescence period prior to CR entry and promotes weight loss during CR.