Backgrounds:
Cardiac rehabilitation with exercise training (CR/ET) has been reported to be associated with reduction in C-reactive protein (CRP) levels in patients with coronary artery disease. However, determinants of reduction in CRP through CR/ET after acute myocardial infarction (AMI) are not fully understood.
Methods:
We studied 490 consecutive AMI patients (age 63±11 years, male 83%) who participated in our CR/ET program and underwent measurements for serum CRP and peak oxygen uptake (PVO2) by symptom-limited cardiopulmonary exercise test at the beginning and the end of the 3-month CR program. Patients with abnormally high CRP (>= 20mg/L at baseline, >=10mg/L at 3 months) or on hemodialysis were excluded.
Results:
After the 3-month CR/ET, body mass index (BMI, 23.3 to 23.1, P<0.001) and CRP (4.7mg/L to 1.1mg/L, P<0.001) significantly decreased, and normalized PVO2 increased (77.4% to 84.9% P<0.001). The magnitude of changes in CRP (ΔCRP) were greater in patients with statin therapy than in patients without statin therapy (-2.9 +/- 0.4mg/L vs -3.9,+/- 0.3mg/L p<0.05). There were significant positive correlation between ΔCRP and HDL-cholesterol (r=0.14), and inverse correlations between ΔCRP and BMI (r=-0.09) and changes in %PVO2 (%ΔPVO2, r=-0.16). Multiple linear regression analysis (incorporating age, sex, baseline ejection fraction, BMI, Brain natriuretic peptide, Hemoglobin A1c, HDL-cholesterol, LDL-cholesterol, statin use, and %ΔPVO2) demonstrated that higher BMI, greater increase in PVO2, higher HDL-cholesterol, and statin use were the independent determinants (all p<0.05) of greater decrease in CRP. Diabetes and smoking status were not the independent determinants of CRP decrease.
Conclusion:
A greater increase in exercise capacity, in combination with obesity and statin use, significantly associated with a greater reduction in CRP in patients after AMI participating in CR/ET.
Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction
