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 (HDLC) 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. Conclusion 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.