Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction

Background: A significant proportion of post-myocardial infarction (MI) patients do not reach target low-density lipoprotein cholesterol (LDL-C) levels. Suboptimal LDL-C reduction is often attributed to poor adherence to pharmacological therapy and lifestyle recommendations. Methods: In a prospectiv...

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Autores: Bertolín-Boronat, C, Merenciano-González, H, Marcos-Garcés, V, Mas, MLM, Alberola, JIC, Civera, JM, Reig, MV, Hueso, MR, Carmona, PC, Perez, N, López-Bueno, L, Díaz, BD, Martínez, IM, Rubio, AP, Ríos-Navarro, C, de Dios, E, Gavara, J, Jiménez-Navarro, MF, Sanchis, J, Bodi, V
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p20125
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/20125
Access Level:acceso abierto
Palabra clave:residual difference
LDL cholesterol
therapeutic adherence
myocardial infarction
cardiac rehabilitation
lifestyle recommendations
Mediterranean diet
exercise testing
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spelling Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial InfarctionBertolín-Boronat, CMerenciano-González, HMarcos-Garcés, VMas, MLMAlberola, JICCivera, JMReig, MVHueso, MRCarmona, PCPerez, NLópez-Bueno, LDíaz, BDMartínez, IMRubio, APRíos-Navarro, Cde Dios, EGavara, JJiménez-Navarro, MFSanchis, JBodi, Vresidual differenceLDL cholesteroltherapeutic adherencemyocardial infarctioncardiac rehabilitationlifestyle recommendationsMediterranean dietexercise testingBackground: A significant proportion of post-myocardial infarction (MI) patients do not reach target low-density lipoprotein cholesterol (LDL-C) levels. Suboptimal LDL-C reduction is often attributed to poor adherence to pharmacological therapy and lifestyle recommendations. Methods: In a prospective registry of 179 post-MI patients who completed a Phase 2 Cardiac Rehabilitation Program (CRP), we evaluated the characteristics and predictors of suboptimal LDL-C reduction. Key indicators were assessed before and after CRP: adherence to the Mediterranean diet (using the PREDIMED questionnaire), weekly physical activity (via the IPAQ questionnaire), therapeutic adherence (using the Morisky-Green questionnaire), and peak oxygen consumption (VO2) on exercise testing. Lipid-lowering therapy (LLT) and LDL-C were recorded prior to MI and both before and after Phase 2 CRP. At the end of Phase 2, we analyzed the difference between measured and theoretical LDL-C (basal LDL-C minus expected LDL-C reduction by LLT), which was defined as "residual difference in LDL-C" (RD-LDL-C). We analyzed the predictors of positive RD-LDL-C (lower than theoretically expected). Results: After CRP, 54 (30.2%) patients exhibited positive RD-LDL-C. Within this subgroup, LLT was uptitrated, and patients received more potent LLT at the conclusion of CRP (theoretical potency: 69.81 +/- 7.07 vs. 66.41 +/- 7.48%, p = 0.005). However, they were less likely to reach the target LDL-C level <55 mg/dL (66.7% vs. 93.6%, p < 0.001). Male sex (HR 17.96 [2.15, 149.92], p = 0.008) and higher lipoprotein (a) levels (HR 1.02 [1.01, 1.03] per mg/dL, p = 0.001) were associated with a positive RD-LDL-C. Conversely, diabetes mellitus (HR 0.17 [0.06, 0.51], p = 0.002), higher corrected basal LDL-C levels (HR 0.98 [0.97, 0.99] per mg/dL, p = 0.001), and supervised in-hospital training during CRP (HR 0.28 [0.09, 0.86], p = 0.03) were associated with a reduced probability of positive RD-LDL-C. No association was found with adherence to the Mediterranean diet (88.1%), therapeutic adherence (89.1%), reported weekly physical activity (median 3545 [1980, 6132] metabolic equivalents per week), or change in peak VO2. Conclusions: More than one-third of post-MI patients demonstrated lower than expected LDL-C reduction (positive RD-LDL-C) following CRP, a finding that could not be attributed to poor adherence to pharmacological therapy or lifestyle recommendations. These findings suggest that a personalized approach to prescribing and uptitrating LLT may help achieve LDL-C targets, particularly in MI patients with healthy lifestyle habits who exhibit a lower response to LLT.MDPI2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/20125Journal of Clinical MedicineISSN: 20770383reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p201252026-06-07T16:35:31Z
dc.title.none.fl_str_mv Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
title Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
spellingShingle Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
Bertolín-Boronat, C
residual difference
LDL cholesterol
therapeutic adherence
myocardial infarction
cardiac rehabilitation
lifestyle recommendations
Mediterranean diet
exercise testing
title_short Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
title_full Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
title_fullStr Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
title_full_unstemmed Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
title_sort Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction
dc.creator.none.fl_str_mv Bertolín-Boronat, C
Merenciano-González, H
Marcos-Garcés, V
Mas, MLM
Alberola, JIC
Civera, JM
Reig, MV
Hueso, MR
Carmona, PC
Perez, N
López-Bueno, L
Díaz, BD
Martínez, IM
Rubio, AP
Ríos-Navarro, C
de Dios, E
Gavara, J
Jiménez-Navarro, MF
Sanchis, J
Bodi, V
author Bertolín-Boronat, C
author_facet Bertolín-Boronat, C
Merenciano-González, H
Marcos-Garcés, V
Mas, MLM
Alberola, JIC
Civera, JM
Reig, MV
Hueso, MR
Carmona, PC
Perez, N
López-Bueno, L
Díaz, BD
Martínez, IM
Rubio, AP
Ríos-Navarro, C
de Dios, E
Gavara, J
Jiménez-Navarro, MF
Sanchis, J
Bodi, V
author_role author
author2 Merenciano-González, H
Marcos-Garcés, V
Mas, MLM
Alberola, JIC
Civera, JM
Reig, MV
Hueso, MR
Carmona, PC
Perez, N
López-Bueno, L
Díaz, BD
Martínez, IM
Rubio, AP
Ríos-Navarro, C
de Dios, E
Gavara, J
Jiménez-Navarro, MF
Sanchis, J
Bodi, V
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv residual difference
LDL cholesterol
therapeutic adherence
myocardial infarction
cardiac rehabilitation
lifestyle recommendations
Mediterranean diet
exercise testing
topic residual difference
LDL cholesterol
therapeutic adherence
myocardial infarction
cardiac rehabilitation
lifestyle recommendations
Mediterranean diet
exercise testing
description Background: A significant proportion of post-myocardial infarction (MI) patients do not reach target low-density lipoprotein cholesterol (LDL-C) levels. Suboptimal LDL-C reduction is often attributed to poor adherence to pharmacological therapy and lifestyle recommendations. Methods: In a prospective registry of 179 post-MI patients who completed a Phase 2 Cardiac Rehabilitation Program (CRP), we evaluated the characteristics and predictors of suboptimal LDL-C reduction. Key indicators were assessed before and after CRP: adherence to the Mediterranean diet (using the PREDIMED questionnaire), weekly physical activity (via the IPAQ questionnaire), therapeutic adherence (using the Morisky-Green questionnaire), and peak oxygen consumption (VO2) on exercise testing. Lipid-lowering therapy (LLT) and LDL-C were recorded prior to MI and both before and after Phase 2 CRP. At the end of Phase 2, we analyzed the difference between measured and theoretical LDL-C (basal LDL-C minus expected LDL-C reduction by LLT), which was defined as "residual difference in LDL-C" (RD-LDL-C). We analyzed the predictors of positive RD-LDL-C (lower than theoretically expected). Results: After CRP, 54 (30.2%) patients exhibited positive RD-LDL-C. Within this subgroup, LLT was uptitrated, and patients received more potent LLT at the conclusion of CRP (theoretical potency: 69.81 +/- 7.07 vs. 66.41 +/- 7.48%, p = 0.005). However, they were less likely to reach the target LDL-C level <55 mg/dL (66.7% vs. 93.6%, p < 0.001). Male sex (HR 17.96 [2.15, 149.92], p = 0.008) and higher lipoprotein (a) levels (HR 1.02 [1.01, 1.03] per mg/dL, p = 0.001) were associated with a positive RD-LDL-C. Conversely, diabetes mellitus (HR 0.17 [0.06, 0.51], p = 0.002), higher corrected basal LDL-C levels (HR 0.98 [0.97, 0.99] per mg/dL, p = 0.001), and supervised in-hospital training during CRP (HR 0.28 [0.09, 0.86], p = 0.03) were associated with a reduced probability of positive RD-LDL-C. No association was found with adherence to the Mediterranean diet (88.1%), therapeutic adherence (89.1%), reported weekly physical activity (median 3545 [1980, 6132] metabolic equivalents per week), or change in peak VO2. Conclusions: More than one-third of post-MI patients demonstrated lower than expected LDL-C reduction (positive RD-LDL-C) following CRP, a finding that could not be attributed to poor adherence to pharmacological therapy or lifestyle recommendations. These findings suggest that a personalized approach to prescribing and uptitrating LLT may help achieve LDL-C targets, particularly in MI patients with healthy lifestyle habits who exhibit a lower response to LLT.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/20125
url https://incliva.portalinvestigacion.com/publicaciones/20125
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv Journal of Clinical Medicine
ISSN: 20770383
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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