Cardiovascular risk factor control in acute coronary syndrome survivors in a cardiac rehabilitation program - are we achieving sustained results?

Abstract Introduction The benefits of cardiac rehabilitation (CR) following acute coronary syndromes (ACS) are well established. CR programs effectively promote a healthy lifestyle and manage risk factors (RF), thereby reducing all-cause and cardiovascular morbidity and improving health related quality of life. Despite its effectiveness, many patients relapse to pre-morbid habits upon returning to their daily routines (1). Purpose To characterize RF control after an exercise-based CR program and relapse 1 year after discharge from the program. Methods We performed a retrospective single-centre cohort study which included patients who were referred to CR program from 2020 to 2022 and completed a phase II exercise-based CR program. Achievement of low-density lipoprotein (LDL) cholesterol, HbA1c, weight loss and smoking cessation was assessed. Lipid profile parameters were assessed and compared at three time points - hospitalization, end of the program and 1 year after primary care follow-up. Results A total of 75 patients were included (85% male, with a mean age of 51.6 + 9.60 years). 61.3% had an ST-elevation myocardial infarction. The most prevalent risk factors were smoking (57.3%), dyslipidemia (54.7%), hypertension (42.7%), obesity (20%) and diabetes mellitus (16.0%). Mean LDL cholesterol at admission was 118 + 55.7mg/dL and 60.1 + 17.9mg/dL at the end of the CRP (p0.001), with 64.4% under the 55mg/dL target. Mean glycated hemoglobin (HbA1c) at admission was 6.35 + 1.65% and 6.16 + 0.76 at the end of the CRP (p=0.114), with 83% under the 7% target. Weight loss was achieved in 40.0% of obese patients and complete smoking cessation in 58.5% of smokers during the CRP. At 1 year follow-up, mean LDL cholesterol was 66.8 + 30.5mg/dL and mean HbA1c 6.69 + 0.96%. Only 40% were under the LDL target and a median weight gain of 2.02kg (7.75 IQR) was also observed. Conclusions This study highlights the efficacy CR program in achieving the treatment targets outlined in the European Society of Cardiology prevention guidelines. There is, however, a pressing need for the implementation of novel strategies aimed at enhancing long- term adherence and maintenance of RF control, particularly within the primary care setting. Addressing this challenge will contribute significantly to the sustained success of cardiovascular health interventions.