CARDIAC REHABILITATION IN PATIENTS WITH DIABETES MELLITUS

AbstractINTRODUCTION: Prevalence of cardiovascular diseases (CVD) is 19.4% in Iran anddiabetes mellitus is an important CVD risk factor in this country. Non-insulin-dependentdiabetes mellitus (type II DM) is associated with increased morbidity and mortality due toatherosclerosis. With cardiac rehabilitation (CR) we can modify CVD risk factors such astype II DM and play an important role in decreasing its mortality and morbidity. Weinvestigated the effects of CR on cardiac patients with and without type II DM.METHODS: In this retrospective before-and-after study we analyzed data from 496 cardiacpatients (419 with type II DM and 77 without type II DM). All of the subjects completeddemographic data questionnaires and underwent weight and height measurement, exercisetest to assess exercise capacity (EC), echocardiography, and blood test to assess lipidprofile and fasting blood glucose. The subjects then participated in a 24-session CRprogram. Each session consisted of 10 minutes warm-up, 40 minutes aerobic exercise, 10minutes cool-down and 20 minutes relaxation. They also took part in 8 educational sessionson life style modification, diet therapy and stress management supervised by CR team (acardiologist, a physician, a physiotherapist, a nurse, a nutritionist and a psychiatrist). At theend of the program, all measurements, exams and tests were repeated. Data were analyzedwith SPSS11.5 using independent t-test at level of P&lt;0.05.RESULTS: We studied 419 non-diabetics (mean age: 55.61&plusmn;9.41 years) and 77 diabetics(mean age: 58.59&plusmn;7.76 years). Mean EC increased significantly after CR in both groups. Inthe diabetic group, EC increased significantly compared to the non-diabetic group(62.21&plusmn;133.40 vs. 33.68&plusmn;31/42, P=0.02). Mean levels of triglyceride, cholesterol, LDLcholesterol,as well as body mass index and heart rate decreased significantly after CR inboth groups. However, no significant difference was seen between the two groups in respectof these variables.DISCUSSION: CR is an effective intervention in diabetics as well as non-diabeticsespecially given its remarkable effects in improving EC as a critical indicator of mortality andmorbidity of diabetic patients. Hence we suggest these patients undergo CR programs.Keywords &bull; Cardiac rehabilitation &bull; Exercise capacity &bull; Diabetes mellitus &bull;Cardiovascularrisk factors</p

PHARMACOLOGICAL TREATMENT, LIFESTYLE MODIFICATION AND AWARENESS IN CORONARY ARTERY AND CEREBROVASCULAR DISEASE PATIENTS

Abstract INTRODUCTION: Cardiovascular diseases (CVD) and cerebrovascular diseases (CeVD) are a large and growing problem in low- and middle-income populations. Secondary prevention, which can reduce the risk of recurrent CVD includes changes in lifestyle, pharmacological interventions and revascularization procedures. The aim of the first phase of this project was to perform situation analysis and identify gaps in secondary prevention of major cardiovascular diseases. This study estimated the physicians' awareness and the patients' knowledge and behavior towards CVD and CeVD complications. It also assessed the efficacy of methods for decreasing recurrent events. methods: A sample of consecutive patients was selected from the outpatient units of the health care facilities selected for the study. Stratified random sampling of primary and secondary private and public health care facilities in cities and villages was performed to select 449 eligible cases. A total of 257 men and 192 women were selected. The inclusion criteria were as follows: Age above 21 years, established diagnosis of CVD and/or CeVD defined as any of the following alone or in combination with others: previous myocardial infarction, stable/unstable angina, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), stroke, transient ischemic attack (TIA), and/or carotid arterectomy. The patients were included if their first event had occurred more than a month, but no earlier than three years before the study. results: The prevalence of high systolic and diastolic blood pressure was 40.1% and 26.9% respectively in MI patients, and 70.1% and 51.2% respectively in CeVD patients. In most of the patients, fasting blood sugar and total cholesterol were within the normal range. Among MI patients, 93.9%, 68.5% and 48.2% were already taking aspirin, beta-blockers and statins, respectively. Among CeVD patients, 79.9%, 61.1% and 23.2% were taking aspirin, beta-blockers and statins, respectively. Blood pressure had been managed in 94.9% and 93.7% of MI and CeVD patients, respectively. Among MI patients, 85.8% and 83.2% had correct behavior towards blood sugar and cholesterol control and 68% had adequate knowledge of the risk of recurrent events. DISCUSSION: Secondary prevention of vascular diseases should be regarded as a key component of public health strategies to reduce the rising burden of CVD and CeVD in Iran.Keywords &bull; Lifestyle modification &bull; Awareness &bull; Myocardial infarction &bull; CeVD</p