Cardiac Rehabilitation Improves Endothelial Function in Coronary Artery Disease Patients

Abstract

Exercise-based cardiac rehabilitation may be an effective nonpharmacological intervention for improving endothelial function in coronary artery disease patients. Therefore, this systematic review with meta-analysis aimed to (a) estimate the training-induced effect on endothelial and vascular smooth muscle function, assessed by flow-mediated dilation and nitroglycerin- mediated dilation, respectively, in coronary artery disease patients; and to (b) study the influence of potential trial-level variables (i. e. study and intervention characteristics) on the training-induced effect on endothelial and vascular smooth muscle function. Electronic searches were performed in Pubmed, Scopus, and Embase up to February 2021. Randomeffects models of standardised mean change were estimated. Heterogeneity analyses were performed by using the Chi2 test and I2 index. Our results showed that exercise-based cardiac rehabilitation significantly enhanced flow-mediated dilation (1.04 [95 % confidence interval = 0.76 to 1.31]) but did not significantly change nitroglycerin-mediated dilation (0.05 [95 % confidence interval = –0.03 to 0.13]). Heterogeneity testing reached statistical significance (p < .001) with high inconsistency for flow-mediated dilation (I2 = 92 %). Nevertheless, none of the analysed variables influenced the training-induced effect on flow-mediated dilation. Exercise-based cardiac rehabilitation seems to be an effective therapeutic strategy for improving endothelial-dependent dilation in coronary artery disease patients, which may aid in the prevention of cardiovascular events.