Managing lipid levels in the life-long rehabilitation of patients with coronary artery disease

Cardiac rehabilitation includes secondary prevention of cardiovascular events. Since the level of LDL cholesterol, which is an important risk factor for cardiovascular events, had been shown to be insufficiently controlled in persons included in the third phase of cardiac rehabilitation in the Coronary Club of Ljubljana, we aimed to explore if an additional educational program would improve the control of blood lipids and self-management ability in these subjects. Members of the Coronary Club of Ljubljana were invited to join a ten-month structured program for the management of cardiovascular risk factors with an emphasis on lipid control. Participation in the program activities was optional. A total of 146 subjects were enrolled. During the study, a slight decrease was seen in the following parameters: total cholesterol, HDL cholesterol, triglycerides and glycated haemoglobin (p<0.05). In the whole group of participants, the median LDL cholesterol level decreased from 2.5 mmol/L (interquartile range [IQR], 1.8-3.4) to 2.2 mmol/L (IQR, 1.7-3.5), but the difference was not statistically significant (p=0.081), while in the participants who attended individual consultations or workshops, a significant decrease in LDL cholesterol levels was observed. At the beginning of the study, very high-risk patients had higher activation, indicated with higher median baseline Patient Activation Measure (PAM) score, than high-risk patients (60.6 versus 55.6). During the study, the median PAM score increased in high-risk patients (from 55.6 to 60.6), but not in very high-risk patients. Thus, an additional educational program can improve lipid control and patient activation in subjects included in the third phase of cardiac rehabilitation.