Biomarker-based risk assessment of dietary intervention in patients with coronary artery disease during cardiac rehabilitation—a quasi-experimental study

Figures

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  Figure 1. Study flow-chart.

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  Figure 2. Changes in body composition across dietary interventions. Significant improvements in body composition during inpatient CR across all dietary groups (low-fat, low-carb, and regular diet) were seen. Data is presented for CAD patients grouped by dietary intervention in terms of: (A) body mass index (BMI), (B) body fat percentage, (C) skeletal muscle mass, (D) visceral fat, and (E) waist-to-hip ratio. Data is presented as mean with 95% confidence interval (CI). *Significant within-group effects, #significant between low-fat/ low-carb and regular diet, §significant between low-fat and low-carb with p < 0.05. ****p < 0.0001, ***p < 0.001, **p < 0.01, *p < 0.05.

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  Figure 3. Impact of dietary interventions on cardiovascular risk reduction during and after cardiac rehabilitation (CR). The predicted mortality risk, assessed by the cardiac rehabilitation biomarker score (CRBS), significantly decreased during inpatient CR across all dietary groups. Further reduction was detected in the low-fat and regular diet group during the six-month follow-up, whereas no further reduction was observed in the low-carb group. The predicted 10-year mortality risk (%) is shown at admission (T0), discharge (T1, after 3–4 weeks of inpatient CR), and after 6 months (T2). Data is presented as mean with 95% confidence interval (CI). p values indicate between-group comparison over time by mixed-effects model (time × group). ****p < 0.0001, ***p < 0.001, **p < 0.01, *p < 0.05.

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  Figure 4. Subgroup-specific risk development across dietary interventions. Subgroup analyses demonstrated that the predicted 10-year mortality risk varied according to patient characteristics across dietary groups (low-fat [green], low-carb [red], and regular diet [blue]). Data is presented for CAD patients grouped by: (A) sex, (B) age, (C) diabetes, (D) disease severity, (E) LVEF function, and (F) obesity. Data is presented as mean with 95% confidence interval (CI). p values indicate between-group comparison over time by mixed-effects model (time × group). T0 (admission), T1 (discharge), and T2 (six-month follow-up). ****p < 0.0001, ***p < 0.001, **p < 0.01, *p < 0.05.

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  Figure 5. Dynamic of blood biomarkers across dietary interventions. Significant changes in blood lipid profiles and glycemic control were observed for dietary groups (low-fat, low-carb, and regular diet) during inpatient CR. Data is presented for CAD patients grouped by dietary intervention in terms of: (A) low-density lipoprotein cholesterol (LDL-C), (B) glycated hemoglobin (HbA1c), (C) total cholesterol, and (D) high-sensitivity C-reactive protein (hsCRP). Data is presented as mean with 95% confidence interval (CI). p values indicate within-group comparison over time by mixed-effects model (time × group). T0 (admission), T1 (discharge), and T2 (six-month follow-up). ****p < 0.0001, ***p < 0.001, **p < 0.01, *p < 0.05.

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  Figure 6. Incidence of major adverse cardiovascular and cerebrovascular events (MACCE) post CR in relation to dietary intervention. Kaplan–Meier curves illustrate the relationship between low-fat/ low-carb diet and regular diet for cardiac rehabilitation biomarker score (CRBS) at the end of CR (n = 205) and the occurrence of MACCE during the mean follow-up period of 470 ± 293 days.