Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Coronary heart disease risk factors before and after bypass surgery: results of a controlled trial on multifactorial rehabilitation
*Department of Medicine, Turku University Central Hospital Turku
Rehabilitation Research Centre of the Social Insurance Institution Turku
Department of Surgery, Turku University Central Hospital Turku, Finland
Received 22 January 1990; revised 13 June 1990; .
Correspondence Erik Engblom MD. Department of Medicine, Turku University Central Hospital. Kiinamyllynkatu4-8. SF-20520 Turku. Finland
Abstract
The effect of a three-phase multfactorial institution-based rehabilitation programme on coronary heart disease (CHD) risk factors was studied in an open randomised trial comprising 228 patients undergoing coronary artery bypass surgery allocated into a rehabilitation (R) group (n = 119) anda hospital (H = control) group (n = 109). Follow-up examinations were performed at 6 and 12 months. Serum total cholesterol and triglyceride levels decreased significantly in both groups during follow-up. These decreases were not significantly dfferent between the R and H groups. Serum high density lipoprotein (HDL) cholesterol level increased significantly at 6 and 12 months in the R group, but not in the H group. The differences in the changes between the groups were not significant. The ratio of serum HDL cholesterol to total cholesterol increased significantly in the R group from the preoperative value of 0.154 to 0.179 (P <0.001) at 6 months and to 0.180 (P<0.001) at 12 months. In the H group these values were 0.152, 0.166 (P<0.001) and 0.168 (P<0.001), respectively. The significance of the differences in the changes between the groups were P = 0.01 at 6 months and 0.06 at 12 months. These dfferences were more obvious in patients aged 55 years or under. There was a signficant decrease (P=0.005) in the proportion of smokers in the R group and a significant increase in the proportion of patients taking regular exercise in both groups as assessed by questionnaire. No changes in blood pressure were observed. The results suggest that favourable changes in serum lipids can be achieved by well organised after-care of patients undergoing coronary artery bypass surgery. The additional benefit from institution-based multifactorial rehabilitation is a greater increase in the ratio of HDL cholesterol to total cholesterol. This effect is more marked in young patients.
Key Words: Aortocoronary bypass • serum lipids • blood pressure • diet • exercise training • rehabilitation • smoking
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