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Cardiac rehab score predicts event risk at 1 year

Cardiac rehab score predicts event risk at 1 year

August 19, 2022

2 min read

The authors report no relevant financial disclosures.

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Exercise performance during cardiac rehabilitation, scored with a novel index, can reliably predict CV event risk at 1 year, according to data from a single-center study.

Participating in a cardiac rehabilitation program is essential to improving patients’ survival and quality of life following myocardial infarction or heart surgery and for patients with HF,” Ofir Koren, MD, FESC, an interventional cardiology fellow with the Cedars-Sinai Medical Center Smidt Heart Institute and a senior interventional cardiologist with Emek Medical Center in Afula, Israel, told Healio. “Our study supports previous evidence and emphasizes the importance of understanding the level of endurance required to promote improved outcomes by designing a simple-to-use formula that can guide physicians and physiotherapists toward a target-directed program.”

Graphical depiction of source quote presented in the article

Data were derived from Naami R, et al. Clin Cardiol. 2022;doi:10.1002/clc.23890.

Koren and colleagues analyzed data from 486 adults who participated in at least 80% of sessions in a cardiac rehabilitation program between January 2018 and August 2021 at Emek Medical Center in Israel. The rehab program is a twice weekly, 3-month government-funded program; each session includes exercises on a treadmill, elliptical, bicycle and handcycle. Researchers assessed patient performance using a novel index, the “CR score,” which integrated duration, speed of work and workload conducted on each training device. Researchers then determined the optimal thresholds for a cumulative CR score and assessed the mortality rate among patients who developed a major adverse CV event and those who did not (controls).

The findings were published in Clinical Cardiology.

Major adverse CV events occurred in 5.5% of patients at 1 year; events were more common among those with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%; P < .001). Age, sex, comorbidities, HF and medical treatment did not affect the outcome.

The median cumulative CR score of the study group was lower compared with controls (median, 595 vs. 3,500; P < .0001). A cumulative CR score of greater than 1,132 correlated with the outcome with 98.5% sensitivity and 99.6% specificity (95% CI, 0.9850.997; P < .0001). Patients older than age 55 years with a cumulative CR score of greater than 1,132 were deemed at highest risk for a major adverse CV event at 1 year, with an OR of 7.4 (95% CI, 2.84-18.42); Kaplan-Meier survival curve indicated that major adverse CV events at 1 year occurred much earlier among patients with a low CR score (log-rank P = .03).

The researchers noted that the CR score is a novel score that has not been validated on a large scale.

“These data may assist physicians and physiotherapists in tailoring a specific CR program with clear physical targets,” Koren, also a clinic lecturer at Technion University in Israel, told Healio. “We need a prospective study involving two groups randomly assigned to two therapeutic options — current CR practice and a CR program directed using our model.”

For more information:

Ofir Koren, MD, FESC, can be reached at; Twitter: @dr_ofir.

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Genetic Mapping Predicts Risk of Cardiovascular Events in People With Type 2 Diabetes

CVD, cardiovascular, heart MRI, cardiac

Risk scores based on genetic mapping were found to correlate with hypertensive blood pressure (BP) traits and an increased likelihood of adverse cardiovascular events, such as stroke, myocardial infarction, and cardiovascular death, in individuals with type 2 diabetes (T2D), according to results of a study published in Hypertension. The risk of adverse cardiovascular events in those with higher genetic risk scores were unchanged by intensive glycemic therapy approaches.

Researchers conducted a post hoc analysis of the National Institutes of Health’s ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial ( Identifier: NCT00000620) to assess whether genetic variants influenced BP traits and adverse cardiovascular outcomes in individuals with T2D. Out of the 10,251 participants with T2D in the ACCORD trial, 6335 individuals had genetic data that were needed to calculate polygenic risk scores.

During the ACCORD trial, BP data were calculated using an average of 3 BP measurements with 5 minutes rest in between measurements. Overall, the median systolic blood pressure was 147 mm Hg, the median diastolic blood pressure was 83 mm Hg, and the median HbA1C was 8.1%.

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For the post hoc assessment, the researchers collected participant genotype data and compared these data with the Trans-OMICs Precision Medicine (TOPMed) Freeze 8 gene map, which consists of more than 1000 genetic variants known to affect blood pressure. The researchers calculated polygenic risk scores based on the number of matches between each participant’s DNA and the genetic variants known to influence BP. The greater the number of matches, the higher the risk score. The median polygenic risk score was 168.4 (range, 166.6-170.6).

After analyzing BP polygenic risk scores in relation to adverse cardiovascular outcomes, each degree of increase in the risk score was found to correlate with a 12% increased risk of cardiovascular events. Glycemic control therapy did not influence the BP polygenic risk scores, nor did it influence the primary outcome of cardiovascular risk prevention.

Study limitations included the pre-existing nature of the subset of participants available for analysis, as well as a lack of power to evaluate possible interactions due to the study’s post hoc design.

“These results invigorate the potential implications of [using] BP polygenic risk score in the primordial prevention of microvascular and macrovascular complications in T2D through early intensification of life-style measures such as healthy diet, exercise, smoking cessation, weight management, and BP control among those with high genetic risk,” the authors said.

This genetic risk assessment may especially benefit those with newly diagnosed T2D and those with prediabetes to encourage earlier adoption of a healthier lifestyle.


Parcha V, Pampana A, Bress AP, Irvin MR, Arora G, Arora P. Association of polygenic risk score with blood pressure and adverse cardiovascular outcomes in individuals with type II diabetes: insights from the ACCORD trial. Hypertension. Published online April 4, 2022. doi:10.1161/hypertensionaha.122.18976