Cardiometabolic profiles of patients enrolled in exercise-based cardiovascular rehabilitation over 25 years: a retrospective cohort study

Abstract Background Cardiovascular Rehabilitation (CR) is an integral component of a comprehensive secondary prevention program that includes exercise training and management of cardiovascular disease (CVD) risk factors (e.g., smoking cessation, psychosocial support, nutritional counselling, vocational assistance). Consensus evidence demonstrates that CR improves quality of life and reduces cardiovascular morbidity and mortality. Mapping baseline clinical profiles is essential for optimally tailoring interventions and educational approaches. Purpose To assess the temporal trends in the cardiometabolic risk profiles of patients enrolled in CR between 2001 and 2025. Methods This observational, retrospective cohort study included baseline cardiometabolic data from patients with CVD who enrolled in CR programs at a large cardiovascular health centre in Canada between 2001 and 2025. All data were extracted in anonymized digital batches from three separate databases, systematically cleaned, and harmonized. Participants were grouped into 5-year enrollment intervals. Baseline measures included body mass index (BMI, kg/m2), waist circumference (cm), resting blood pressure (BP) (mmHg), glucose (mmol/L) or HbA1c (%), triglycerides, total cholesterol, LDL, and HDL (all mmol/L). One-way ANOVA, with Bonferroni post-hoc tests, was used to compare changes in these measures over time. Chi-square analyses, with post-hoc tests, were used to compare the proportion of participants above or below the guideline cut-offs. Waist circumference was available between 2001 and 2020, whereas glucose/HbA1c and lipid values were not available between 2016 and 2020. Results A total of 27,489 patients (mean SD age, 62 12 years; 29.5% women; 60.7% with coronary artery disease) with at least one available risk factor measure were included. Significant fluctuations occurred over time (p0.001 for all), including a median reduction in BMI by 0.8 kg/m2 and in systolic BP by 7 mmHg between 2001-2005 and 2021-2025. The proportion of participants with normal BMI decreased from 26% (2001-2005) to 19% (2006-2010), then increased from 20% (2016-2020) to 30% (2021-2025). Similarly, the proportion of participants with normal BP increased from 34% (2006-2010) to 41% (2021-2025), decreased to 36% (2016-2020), but increased again to 46% (2021-2025). The proportion of patients with optimal lipid levels fluctuated (triglycerides 1.7 mmol/L: 69-76%; total cholesterol 5.2 mmol/L: 75-91%; LDL 2.6 mmol/L: 63%-84%; HDL women 1.3 and men 1.0 mmol/L: 41-57%). Yet, the proportion of patients with optimal glucose/HbA1c levels (glucose 2.6 mmol/L or HbA1c 5.7%) declined from 75% 2001-2005 to 67% 2021-2025. Conclusion Meaningful improvements in several cardiometabolic risk factors of CR patients when enrolling in programs over two decades highlight the improvement in disease management. Yet, persistent metabolic risk highlights the need for intensified and tailored multi-component interventions.