Key result
Exercise-based cardiac rehab shows promise as first-line stable angina treatment targeting systemic vascular dysfunction.
Why the study?
Because the need for revascularisation added to optimal medical treatment in stable angina pectoris is heavily debated, alternative systemic physiological approaches such as exercise-based cardiac rehabilitation warrant consideration.
Does exercise-based cardiac rehabilitation improve outcomes in patients with stable angina pectoris?
Does exercise-based cardiac rehabilitation improve outcomes in patients with stable angina pectoris?
Exercise-based cardiac rehabilitation is proposed as a promising first-line treatment for stable angina pectoris, targeting systemic vascular dysfunction rather than just local flow-limiting lesions.
Stable angina pectoris (SAP) is a prevalent condition characterised by a high disease burden. Based on recent evidence, the need for revascularisation in addition to optimal medical treatment to reduce mortality and re-events is heavily debated. These observations may be explained by the fact that revascularisation is targeted at the local flow-limiting coronary artery lesion, while the aetiology of SAP relates to the systemic, inflammatory process of atherosclerosis, causing generalised vascular dysfunction throughout the entire vascular system. Moreover, cardiovascular events are not solely caused by obstructive plaques but are also associated with plaque burden and high-risk plaque features. Therefore, to reduce the risk of cardiovascular events and angina, and thereby improve quality of life, alternative therapeutic approaches to revascularisation should be considered, preferably targeting the cardiovascular system as a whole with a physiological approach. Exercise-based cardiac rehabilitation fits this description and is a promising strategy as a first-line treatment in addition to optimal medical treatment. In this review, we discuss the role of exercise-based cardiac rehabilitation in SAP in relation to the underlying physiological mechanisms, we summarise the existing evidence and highlight future directions.
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Heutinck et al. (2023) conducted a review in Stable angina pectoris. Exercise-based cardiac rehabilitation vs. Revascularization and/or optimal medical therapy was evaluated. Exercise-based cardiac rehabilitation is a promising first-line treatment for stable angina pectoris that targets systemic vascular dysfunction and may complement or replace revascularization.
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