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The association between body composition changes following cardiac rehabilitation and major adverse cardiovascular events: a community based study

Session Young Investigator Award 3 - Secondary prevention and rehabilitation Section

Speaker Doctor Jose R Medina-Inojosa

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Young Investigator Award Abstracts

Authors : J R Medina-Inojosa (Rochester,US), I Barillas (Rochester,US), JR Smith (Rochester,US), TP Olson (Rochester,US), D Yaoshan (Rochester,US), F Lopez-Jimenez (Rochester,US), M Bonikowske (Rochester,US)

J R Medina-Inojosa1 , I Barillas1 , JR Smith1 , TP Olson1 , D Yaoshan1 , F Lopez-Jimenez1 , M Bonikowske1 , 1Mayo Clinic - Rochester - United States of America ,

Secondary Prevention

Purpose: Cardiac rehabilitation (CR) reduces major cardiovascular events (MACE). The association between body composition changes following CR participation and MACE has not been extensively studied.

Methods: We included consecutive CR patients that underwent dual energy x-ray absorptiometry (DXA) before and after CR from 2014 to 2018. Clinical and DXA information were extracted from the medical record and passive follow-up was performed using a record linkage system for the composite outcome of MACE, that included acute coronary syndromes, coronary revascularization, stroke, arrhythmias that warranted in hospital management or death from any cause. The association between body fat percentage (BF%) loss (defined as any reduction in BF% after CR) and muscle gain (defined as any increase in lean mass (kg) after CR) with MACE was assessed with Kaplan-Meier curves and Cox-proportional hazard models that adjusted for potential confounders.

Results: Among 288 patients (71% male), mean±SD age was 64.4±13.8 years, and completed 33 (IQR 14-36) CR sessions, 189 (66%) reduced BF% and 172 (60%) gained muscle. Mean BF% change was -2.1±1.51% and 1.20±1.25%, in reducers vs not, respectively. A total of 172 (59%) improved lean muscle mass (kg), change was 1.6±1.46kg and -1.6±1.81kg in gainers vs not, respectively. A total of 32 (11%) events occurred over a median follow-up of 2.05±0.73 years. Body fat % reduction during CR was not associated with MACE (HR=0.64 95%CI, 0.31-1.31, p=0.2, see Figure 1-A). However, the risk of MACE was reduced in those that gained muscle during CR (HR=0.43, 95%CI, 0.21-0.88, p=0.02), when compared to those that did not, see Figure 1-B. This remained constant after adjusting for age and sex (HR=0.46, 95%CI, 0.22-0.93, p=0.03) and was independent of age, sex, body mass index, CR sessions, hypertension and dyslipidemia (HR=0.43, 95%CI, 0.20-0.89, p=0.02)

Conclusions: In patients participating in CR, muscle gain, not fat loss was associated with a reduction in MACE events. These results highlight the importance of body composition assessment in CR and suggest an increased importance of gaining lean mass through strength training or other aerobic/anaerobic muscle developing exercises.

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