Gender differences in risk profile and response to a cardiac rehabilitation program after an acute coronary syndrome

Abstract

Objectives: Women have a different distribution of lifestyle risk factors of coronary artery disease than men. In order to define the priorities of a cardiac rehabilitation program (CRP) for women, we compared the risk profile and the response to a CRP of women vs. men, in a cohort of patients with a recent admission for ACS submitted to our CRP. Material and methods: We studied 694 patients, 96 women (13.5%) and 598 men. We compared the risk profile and the modification of lifestyle related risk factors after an 8-week exercise-based CRP between men and women. Results: Men and women presented a similar distribution of risk factors (Table 1), except for abdominal obesity, which was the most prevalent risk factor in women and was significantly more prevalent in women compared to men, and for overweight. Functional capacity in METs assessed by a symptoms-limited exercise test on admission to CRP was significantly lower in women (6.3 vs. 7.9 METs, p <0.001). Adherence to CRP and usual pharmacological measures for secondary prevention were similar in both men and women. After CRP, both women and men experienced an important improvement in functional capacity (gain in METs 3.6 vs. 3.5, p=NS). However, despite dietary recommendations, only 25% of overweight women lost weight (average loss of 0.5 kg at the end of the program), and abdominal girth loss was modest in general, and significantly lower in women than in men (1.2 vs. 2.2 cm of abbominal girth reduction). At 3 months, only 74% of female smokers remained abstinent compared to 86% of men (p<0.05). This difference became greater at 12 months follow up (59% vs. 80% of abstinence, p<0.001). (Table presented) Conclusions: Men and women with a recent ACS submitted to our CRP have a similar risk profile in general terms, but show a different response to lifestyle modification interventions. CRP should reinforce smoking cessation, diet and physical exercise interventions in women, to promote adherence to recommendations in these minority group of patients.