EFFICACY OF PHYSICAL TRAINING AND ANALYSIS OF LIPID-LOWERING THERAPY IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER ACUTE CORONARY INCIDENTS

Aim. To study efficacy of moderate-intensity physical training (PT) and evaluate lipid-lowering therapy in patients with ischemic heart disease (IHD) after acute coronary events in real practice.

Material and methods. A total of 392 patients survived during last 3-8 weeks myocardial infarction, unstable angina or myocardial revascularization were included into the study. Inclusion of patients with stable angina pectoris after hospital treatment was also possible. Patients were randomized to the main (n=197) and control (n=195) groups. Patients of the main group received moderate-intensity PT. All patients received beta-blocker, nitrate, ACE inhibitors and acetylsalicylic acid. Frequency of lipid-lowering therapy prescription and its efficacy were assessed in both groups. Duration of the study was 1 year. The efficacy of interventions was evaluated by the dynamics of plasma lipid levels, results of bicycle ergometry and clinical end points.

Results. We observed increase in exercise test duration by 32% (p<0.001), efficiency of heart work by 12% (p<0.05), decrease in frequency of angina attacks by 51% (p<0.001) in the main group. Decrease in total cholesterol (TC) by -3.6% (p<0.05) and increase in high density lipoproteins (HDL) cholesterol by 12.3% (p<0.01) were also observed. Differences in the dynamics of physical tolerance, levels of TC, HDL cholesterol and the TC/HDL cholesterol ratio were significant at intergroup comparison. Lipid-lowering drugs implementation was inadequate in both groups. Target plasma levels of low density lipoproteins (LDL) cholesterol were reached in no one group. We registered less cardiovascular events in the main group in comparison with control one (14% vs 28%, respectively) as well as hospitalizations due to IHD (11% vs 18%, respectively) and number of days of disability (2.2 vs. 4.2 days per patient annually, respectively). Differences in mentioned clinical end point rates were significant between groups (p<0.05).

Conclusion. Results of the study shown PT efficacy in patients with IHD after cardiovascular events. Lipid-lowering therapy is conducted inefficiently in patients with IHD in real practice. It is advisable to introduce PT program in real practice as well as adequate pharmacotherapy.

1. Levi F., Lucchini F., Negri E., La Vecchia C. Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart 2002;88(2):119-24.

2. Bale B.F., Doneen A.L., Drueding R. et al. Aggressive risk factor modification in patients with subclinical atherosclerosis reduces plaque burden and regresses carotid artery wall thickness (abstract). Atherosclerosis. 2006;7(Suppl):161.

3. Aronov D.M. Cardiac rehabilitation of patients with IHD: prescription for Russia. Lechashchiy Vrach 2007;(3):22-6 (In Russian). / Aronov D.M. Kardioreabilitatsiya bol'nykh IBS: retsept dlya Ros- sii. Lechashchii vrach 2007;(3):22-6.

4. Boden W.E., O'Rourke R.A., Teo K.K. et al., COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-16.

5. O'Connor G.T., Buring J.E., Yusuf S. et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989;80(2):234-44.

6. Aronov D.M. Treatment and prevention of atherosclerosis. Moscow, Triada-X; 2000. (In Russian). / Aronov D.M. Lechenie i profilaktika ateroskleroza. M.: Triada-Kh; 2000.

7. Hornig B., Maier V., Drexler H. Physical training improves endothelial function in patients with chronic heart failure. Circulation 1996;93(2):210-4.

8. Schuler G., Hambrecht R., Schlierf G. et al. Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease. Circulation 1992;86(1):1-11.

9. Taylor R.S., Brown A., Ebrahim S. et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116(10):682-92.

10. Oganov R.G., AronovD.M. Topical issues of patients’ with cardiovascular diseases rehabilitation. Fizioterapia, Bal’neologiya i Reabilitatsiya 2002;(1):10-5. (In Russian). / Oganov R.G., Aronov D.M. Aktu- al'nye voprosy reabilitatsii bol'nykh s serdechno-sosudistymi zabolevaniyami. Fizioterapiya, bal'neologiya i reabilitatsiya 2002;(1):10-5.

11. Smith S.C. Jr., Feldman T.E., Hirshfeld J.W. Jr. et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006;47(1):e1-121.

12. Diagnosis and treatment of patients with acute ST elevation myocardial infarction. Russian guidelines. Moscow, VNOK, 2007. (In Russian). / Diagnostika i lechenie bol'nykh ostrym infarktom miokarda s pod"emom segmenta ST elektrokardiogrammy. Rossiiskie rekomendatsii. M.: VNOK; 2007.

13. Aronov DM, Krasnitskiĭ VB, Bubnova MG, et al. Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia). Ter Arkh. 2006;78(9):33-8 (In Russian). / Aronov D.M., Krasnitskii V.B., Bubnova M.G. i dr. Fizicheskie trenirovki v kompleksnoi reabilitatsii i vtorichnoi profilaktike na ambulatorno-poliklinicheskom etape u bol'nykh ishemicheskoi bolezn'yu serdtsa posle ostrykh koronarnykh intsidentov (Rossiiskoe kooperativnoe issledovanie). Ter arkh 2006;78(9): 33-8.

14. AronovDM, Krasnitskiĭ VB, Bubnova MG, et al. Physical training at ambulatory-polyclinic stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamic, blood lipids, clinical course and prognosis (Russian cooperative study). Kardiologiia 2009; 49 (3):49-56 (In Russian). / Aronov D.M., Krasnitskii V.B., Bubnova M.G. i dr. Vliyanie fizicheskikh trenirovok na fizicheskuyu rabotosposobnost', gemodinamiku, lipidy krovi, klinicheskoe techenie i prognoz u bol'nykh ishemicheskoi bolezn'yu serdtsa posle ostrykh koronarnykh sobytii pri kompleksnoi reabilitatsii i vtorichnoi profilaktike na ambulatorno-poliklinicheskom etape (Rossiiskoe kooperativnoe issledovanie). Kardiologiya 2009;49(3):49-56.

15. Oganov RG, Aronov DM, Krasnitskiĭ VB. Cooperative study "post hospital rehabilitation of patients with coronary heart disease after acute coronary incidents" conducted in Moscow region. Kardiologiia 2004;44(11):17-23. (In Russian). / Oganov R.G., AronovD.M., Krasnitskii V.B.Moskovskoe oblastnoe kooperativnoe issledovanie «Poststatsionarnaya reabilitatsiya bol'nykh ishemicheskoi bolezn'yu serdtsa posle ostrykh koronarnykh intsidentov». Kardiologiya 2004;44(11):17-23.

16. Fletcher B.J., Dunbar S.B., Felner J.M. et al. Exercise testing and training in physically disabled men with clinical evidence of coronary artery disease Am J Cardiol 1994;73(2):170-4.

17. Wenger N.K., Froelicher E.S., Smith L.K., et al. Cardiac Rehabilitation. Clinical Practice Guideline№17. Rockville, MD: U.S.Department ofHealth andHuman Services, PublicHealth Service, Agency forHealth Care Policy and Research and National Heart, Lung, and Blood Institute. AHCPR Publication No. 96- 0672. October 1995.

18. Zagidullin N.Sh., Zagidullin Sh.Z. Statin therapy compliance. Kardiovaskulyarnaya Terapiya I Profilaktika 2008;(1):107-11. (In Russian). / Zagidullin N.Sh., Zagidullin Sh.Z. Priverzhennost' te- rapii statinami. Kardiovaskulyarnaya terapiya i profilaktika 2008;(1):107-11.

19. Yilmaz M.B., Biyikoglu S.F., Guray Y. et al. Level of awareness of on-treatment patients about prescribed statins. Cardiovasc Drugs Ther 2004;18(5):399-404.