Key result
Cardiac rehabilitation in ethnic minorities yields equivalent BP and cholesterol improvements but less BMI reduction.
Why the study?
The benefits of cardiac rehabilitation for cardiovascular risk factors, mortality, and morbidity among ethnic minorities compared to majority reference groups were not established.
Does cardiac rehabilitation provide equivalent benefits for cardiovascular risk factors, mortality, and morbidity in ethnic minorities compared to majority groups?
Meta-Analysis (n=132,109)
Does cardiac rehabilitation provide equivalent benefits for cardiovascular risk factors, mortality, and morbidity in ethnic minorities compared to majority groups?
Effect estimate: MD -0.69 (95% CI -1.62 to 0.24)
Cardiac rehabilitation provides equivalent benefits for most cardiovascular risk factors and mortality in ethnic minorities compared to majority groups, though targeted interventions may be needed for adiposity.
Supports broad cardiac rehabilitation access for ethnic minorities; extends evidence by highlighting BMI as a disparity needing targeted study.
PURPOSE: To determine the benefits of cardiac rehabilitation (CR) among ethnic minorities for cardiovascular risk factors (systolic blood pressure [BP], exercise capacity, lipids, body fat), mortality, and morbidity, and compare outcomes to majority reference groups. REVIEW METHODS: We searched electronic databases (Medline, EMBASE, CINAHL, Scopus, Cochrane Library) from inception until September 2023 for studies reporting CR outcomes of ethnic minorities. Meta-analyses were conducted for data that could be pooled using random effects model. Data that were not suitable for meta-analysis were synthesized and reported narratively. SUMMARY: Thirteen studies with a total of 132 109 participants (10 494 from ethnic minorities [8% of total participants]) were included. Patients from ethnic minority groups made improvements in several outcomes post-CR. These outcomes were equivalent to majority groups for systolic BP (Mean Difference [MD] = -0.69: 95% CI, -1.62 to 0.24 mmHg), maximal exercise capacity (MD = -0.10: 95% CI, -0.63 to 0.44 metabolic equivalents of task), total cholesterol (MD = 0.16: 95% CI, -0.01 to 0.33 mmol/L), and low-density lipoprotein cholesterol (MD = 0.25: 95% CI, -0.04 to 0.54 mmol/L). However, ethnic minorities achieved less improvements than the majority for body mass index (MD = -0.31: 95% CI, -0.47 to -0.14 kg/m2) and waist circumference (MD = -1.50: 95% CI, -2.33 to -0.68 cm). Narrative synthesis indicated equivalent outcomes for minorities for all-cause mortality and mean cholesterol, with worse risk of hospitalization at 1 year. Patients from ethnic minorities attending CR achieve equivalent benefits to majority counterparts for multiple risk factors and potentially mortality and morbidity, therefore CR should be strongly promoted. Individual tailoring may be needed to address adiposity and exercise capacity.
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Duggan et al. (2025) conducted a meta-analysis in Cardiovascular disease requiring cardiac rehabilitation (n=132,109). Cardiac rehabilitation vs. Majority reference groups was evaluated on Systolic blood pressure (MD -0.69, 95% CI -1.62 to 0.24). Cardiac rehabilitation in ethnic minorities yielded equivalent improvements to majority groups for systolic blood pressure (MD -0.69 mmHg; 95% CI -1.62 to 0.24) and cholesterol, but less for BMI.
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