Association of Cardiac Rehabilitation with Improvement in High Sensitive C-Reactive Protein Post-Myocardial Infarction

Dear Editor, Atherosclerotic cardiovascular diseases are the major cause of death in middle-aged and older-adults. 1,2 Today, inflammation is regarded as the key patho-genic mechanism in both initiation and progression of atherosclerosis. 3 Inflammatory markers such as high sensitive C-reactive protein (CRP) have been used to identify patients at higher risk for coronary events. The prognostic value of CRP has been established for patients with acute coronary syndrome, stable coronary artery diseases 4 and in apparently healthy people. Comprehensive cardiac rehabilitation is probably the most effective approach for cardiovascular reduction and long-term care of cardiac patients as well as subjects with multiple coronary risk factors. 7,8 Secondary prevention, through cardiac rehabilitation program is now regarded as an essential component of contemporary management of patients with various presentations of coronary disease. 9 There are some evidences that protective effects of cardiac rehabilitation may in part be related to lowering of inflammation. The goal of this prospective study was to assess the effect of cardiac rehabilitation on high sensitive CRP as a marker of increased risk of coronary artery disease. The subjects were randomly selected from patients with recent anterior wall myocardial infarction referring to Alzahra Cardiac Rehabilitation Center in Shi-raz from May to December 2007. Inclusion criteria were males and females aged 30-75 years with anterior wall MI in past 1 month. Patients were divided into two groups. Group A consisted of 30 participants who received cardiac rehabilitation and group B consisting of 26 participants which did not receive any cardiac rehabilitation program. CRP levels were assessed before starting the program and eight weeks later. We used CRP Quantitative Diagnostic Kit for serum and plasma-Photometry technique. The data were analyzed by Wilcoxon Signed Rank and Mann-Whitney tests. The cardiac rehabilitation program included 8 weeks of exercise training, education and behavior modification therapy 3 times per week. The exercise training included arm and leg ergometry and tread-mills. Behavioral modifications were smoking cessation , healthy nutrition, hypertension control, etc. The average age of patients was 62.7 years old. At enrollment, 66% (n=20) of participants in cardiac rehabilitation (group A) had CRP levels in the intermediate and high-risk range of >1 mg/dl and after completion of cardiac rehabilitation only 27% (n= 5) of patients had elevated CRP levels (p=0.0009). In the group B, 73% (n=19) of participants had CRP levels >1 mg/dl and after eight weeks, 53% (n=14) of them had CRP levels >1 …