ORIGINAL ARTICLE Differential Improvements in Lipid Profiles and Framingham Recurrent Risk Score in Patients With and Without Diabetes Mellitus Undergoing Long-Term Cardiac Rehabilitation Sean Carroll, PhD, Costas Tsakirides, MSc, James Hobkirk, BSc, James W.A. Moxon, MBChB, James W.D. Moxon, MBBS, DipSportMed, Michael Dudfield, MSc, Lee Ingle, PhD ABSTRACT. Carroll S, Tsakirides C, Hobkirk J, Moxon JWA, Moxon JWD, Dudfield M, Ingle L. Differential improve- ments in lipid profiles and Framingham recurrent risk score in patients with and without diabetes mellitus undergoing long- term cardiac rehabilitation. Arch Phys Med Rehabil 2011;92: 1382-7. Objective: To determine whether lipid profiles and recurrent coronary heart disease (CHD) risk could be modified in pa- tients with and without diabetes mellitus undergoing long-term cardiac rehabilitation (CR). Design: Retrospective analysis of patient case records. Setting: Community-based phase 4 CR program. Participants: Patients without diabetes (n=154; 89% men; mean  SD age, 59.68.5y; body mass index [BMI], 27.03.5kg/m 2 ) and patients with diabetes (n=20; 81% men; mean age, 63.08.7y; BMI, 28.73.3kg/m 2 ) who completed 15 months of CR. Interventions: Exercise testing and training, risk profiling, and risk-factor education. Main Outcome Measures: Cardiometabolic risk factors and 2- to 4-year Framingham recurrent CHD risk scores were assessed. Results: At follow up, a significant main effect for time was evident for decreased body mass and waist circumference and improved low-density lipoprotein cholesterol (LDL-C) level and submaximal cardiorespiratory fitness (all P.05), showing the benefits of CR in both groups. However, a significant group-by-time interaction effect was evident for high-density lipoprotein cholesterol (HDL-C) level and total cholesterol (TC)/HDL-C ratio (both P.05). TC/HDL-C ratio improved (5.01.5 to 4.41.3) in patients without diabetes, but showed no improvement in patients with diabetes (4.81.6 v 4.91.6). Conclusions: We showed that numerous anthropometric, sub- maximal fitness, and cardiometabolic risk variables (especially LDL-C level) improved significantly after long-term CR. How- ever, some aspects of cardiometabolic risk (measures incorpo- rating TC and HDL-C) improved significantly in only the nondiabetic group. Key Words: Cardiac rehabilitation; Cardiometabolic risk; Cardiorespiratory fitness; Exercise training; High-density lipo- protein cholesterol; Low-density lipoprotein cholesterol; Reha- bilitation; Type 2 diabetes. © 2011 by the American Congress of Rehabilitation Medicine S EVERAL RECENT REPORTS from contemporary large international databases, such as the REeduction of Athero- thrombosis for Continued Health Registry, showed that stable outpatients with coronary heart disease (CHD), especially those with concomitant diabetes, experience high rates of sub- sequent CHD events despite the use of various standard med- ications and medical treatments. 1 International survey data also showed substantial residual cardiometabolic risk in patients with CHD, especially obesity, dyslipidemia, increased blood pressure, and impaired glucose tolerance. These are highly prevalent, largely undertreated, and undercontrolled. 2-4 The need for intensive, longitudinal, multimodal optimal medical therapy in high-risk CHD groups 5 has been reiterated recently. 6-10 Several studies 11-16 reporting somewhat conflict- ing results compared the effects of cardiac rehabilitation (CR) between patients with and without diabetes. Moreover, long- term lifestyle–induced improvements in cardiometabolic risk factors in patients with type 2 diabetes without CHD also were inconsistent. 17,18 Therefore, the aim of our study was to eval- uate the impact of a 15-month comprehensive outpatient CR program on cardiometabolic and Framingham recurrent risk profiles in cardiac patients with and without diabetes mellitus. From the Leeds Metropolitan University, Leeds, United Kingdom. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organi- zation with which the authors are associated. Correspondence to Lee Ingle, PhD, Carnegie Research Institute, 209 Fairfax Hall, Leeds Metropolitan University, Beckett Park, Headingley, Leeds LS6 3QS, UK, e-mail: l.ingle@leedsmet.ac.uk. Reprints are not available from the author. 0003-9993/11/9209-00039$36.00/0 doi:10.1016/j.apmr.2011.04.013 List of Abbreviations 4S Scandinavian Simvastatin Survival Study BMI body mass index CHD coronary heart disease CR cardiac rehabilitation CRF cardiorespiratory fitness DANSUK DANish StUdy of impaired glucose metabolism in the settings of cardiac rehabilitation ECG electrocardiogram ETT exercise tolerance test EUROASPIRE European Action on Secondary Prevention through Intervention to Reduce Events FRS Framingham risk score HDL-C high-density lipoprotein cholesterol LDL-C low-density lipoprotein cholesterol RPE rating of perceived exertion SCRIP Stanford Coronary Risk Intervention Project TC total cholesterol 1382 Arch Phys Med Rehabil Vol 92, September 2011