Temporal trends in sociodemographic and risk factors among patients enrolled in cardiovascular rehabilitation over 25 years

Abstract Aims We aimed to assess the temporal trends in sociodemographic characteristics, cardiometabolic risk factors, and health behaviours among patients enrolled in cardiovascular rehabilitation (CR) between 2001 and 2025. Methods A retrospective cohort study of patients with cardiovascular diseases who enrolled in a CR program at Canada's largest cardiovascular health centre between 2001 and 2025. Baseline measures included sociodemographic variables, cardiometabolic risk factors, physical activity, smoking status, nutritional profile, and mental health factors. Results Among 40,822 participants (mean (SD) age, 63 (13) years; 30.7% females; 59.5% with coronary artery disease), sociodemographic diversity significantly increased over the two decades. A significant temporal trend toward older age with participant age increasing by 0.3 years annually (p < 0.001). Participants also had progressively greater odds of being female (OR=1.004; 95% CI: 1.001-1.008; p = 0.02), non-White (OR=1.02; 95% CI: 1.01-1.03; p < 0.001) and not married (OR=1.02; 95% CI: 1.02-1.03; p < 0.001), while the odds of being occupationally inactive decreased over time (OR=0.95; 95% CI: 0.94-0.96; p < 0.001). Atherosclerotic coronary artery disease was the predominant cardiovascular condition (59%), followed by valvular heart disease (14%) and arrhythmias (10%). Significant annual decreases were observed in systolic blood pressure (-0.37; 95% CI: -0.41 – -0.33; p < 0.001) and LDL cholesterol (-0.02; 95% CI: -0.02 – -0.02; p < 0.001). The odds of low moderate-to-vigorous physical activity (OR=0.98; 95% CI: 0.98–0.99; p < 0.001) and moderate-to-high anxiety symptoms (OR=0.98; 95% CI: 0.98–0.99; p < 0.001) also declined over time. Conclusion Despite encouraging trends toward greater diversity, females, non-White individuals, and those with lower educational attainment remain underrepresented in CR, highlighting persistent equity gaps in enrollment. Additionally, encouraging improvements were observed in key cardiometabolic and behavioural risk factors, including lower blood pressure and LDL cholesterol levels, reduced physical inactivity, and fewer anxiety symptoms.