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(Circulation. 1995;92:773-777.)
© 1995 American Heart Association, Inc.

Articles

Long-term (5-Year) Changes in HDL Cholesterol in Cardiac Rehabilitation Patients

Do Sex Differences Exist?

James G. Warner, Jr, MD, EdD; Peter H. Brubaker, PhD; Ying Zhu, MS; Timothy M. Morgan, PhD; Paul M. Ribisl, PhD; Henry S. Miller, MD; David M. Herrington, MD, MHS

From the Section of Cardiology, Department of Internal Medicine, and Department of Health and Sports Science, The Bowman Gray School of Medicine and Wake Forest University, Winston-Salem, NC.

Correspondence or reprint requests to James G. Warner, Jr, MD, EdD, Section of Cardiology, The Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045.

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.

Methods and 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=.0001), 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.

Key Words: lipoproteins • cholesterol • rehabilitation

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