Clinical Review

Poor Outcomes for African Americans in Cardiac Rehabilitation


African Americans—especially women and patients with diabetes—may need targeted interventions to make the most of cardiac rehabilitation (CR). A study at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, found that the CR program benefited all participants, but some more than others.

The study enrolled 169 African American patients and 927 white patients in a 12-week, 36-session CR program for ischemic heart disease or post cardiac surgery. The sessions included walking on a track or treadmill, using a stair climber, and engaging in light resistance exercise.

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Both groups derived significant benefits from the CR, but the researchers also found substantial differences both at baseline and at follow-up. Overall, African Americans had lower baseline exercise capacity. They were also younger, more likely to be female, and had a higher prevalence of hypertension and diabetes compared with white patients.

White men saw the most improvements in outcomes such as quality of life, decreased risk factors, and exercise capacity; white women, to a lesser extent, also saw improvements. African Americans saw smaller gains. Moreover, although their blood pressure and low-density lipoprotein cholesterol (LDL-C) improved, weight, triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C) concentrations did not.

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Exercise capacity increased the least in African American women. Their body weight also declined only slightly, and body mass index remained unchanged. Similar to African American men, African American women did not notably improve in TGs or HDL-C concentrations, and LDL-C did not decline as much as was observed in white women.

Why African American women did not improve as much in this study is unclear, the researchers say. Although statin use was the same in both groups, the researchers say it is possible that African American women may require more potent dosages and/or more time to reach therapeutic goals.

African American patients with diabetes also did not fare as well as others in the study. Their “suboptimal” results included no significant weight loss, even in those patients who were obese. A “striking ethnic difference,” the researchers say, was seen in TG concentrations, which decreased by 50% in white participants with diabetes but remained unchanged in African Americans.

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Their findings have implications for secondary prevention of coronary disease in African Americans, the researchers say. The research may also help target individuals or groups who may benefit most from focused treatment.

Johnson D, Sacrinty M, Mehta H, Douglas C, Paladenech C, Robinson K. Am Heart J. 2015;169(1):102-107.
doi: 10.1016/j.ahj.2014.09.009.

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