Coronary heart disease, including acute coronary syndromes (ACS), is the leading cause of death in European countries. One of the basic elements of secondary and tertiary prevention of ACS is cardiac rehabilitation. The aims of the study are evaluation of the impact of cardiac rehabilitation on health state- especially on cardiovascular function parameters in patients after acute coronary syndrome and evaluation of the influence of the level of gene expression and polymorphisms of genes associated with ischemic heart disease on the course of cardiac rehabilitation in patients after ACS. The study will consist of a retrospective and prospective part. The retrospective part will include patients who have had acute coronary syndrome in the past and then - before being included in the study - have undergone cardiac rehabilitation. In the retrospective part, patients enrolled in the study will not undergo cardiac rehabilitation as a part of the study intervention. The prospective part will include patients who have had an acute coronary syndrome in the past and will undergo cardiac rehabilitation as the study intervention. After being included in the study, patients will undergo medical examination. Then subsequent procedures will be performed: anthropometric measurements; ECG; body composition analysis by bioimpedance; measurement of resting blood pressure, resting heart rate and oxygen saturation of hemoglobin; pulse wave analysis; transthoracic echocardiography of the heart; 24-hour blood pressure measurement by ambulatory blood pressure monitoring (ABPM); 24-hour ECG recording using the Holter method; electrocardiographic exercise test on a treadmill and / or a six-minute walk test or other exercise test adequate to the patient's state of health; assessment of the quality of the diet; assessment of lifestyle, acceptance of disease and quality of life; assessment of the psychological profile. Subsequently patients taking part in the prospective part of the study will perform a cardiac rehabilitation program. After the cardiac rehabilitation program measurement procedures listed above will be repeated. Before and after the cardiac rehabilitation program blood samples, urine samples and hair samples will be collected. Blood samples, urine samples and hair samples will also be collected from patients taking part in the retrospective part of the study.
Coronary heart disease, including acute coronary syndromes (ACS), is the leading cause of death in European countries, including Poland. In addition, it is one of the main causes of disability and the number of lost years of life and the number of years of life lost in good health. The costs of its treatment include not only the primary prophylaxis of cardiovascular events, the treatment of cardiovascular events, the treatment of chronic conditions and complications such as chronic heart failure or arrhythmia, but also the secondary and tertiary prophylaxis of acute coronary syndromes. One of the basic elements of secondary and tertiary prevention of ACS is cardiac rehabilitation. It should be implemented as soon as possible after the ACS and be part of a comprehensive, planned and systematic care of the patient after ACS. The beneficial effect of cardiac rehabilitation on the cardiovascular system, lipid and carbohydrate metabolism and physical performance has been demonstrated in a way that does not raise any doubts. However, in the light of the growing epidemic of civilization diseases such as excessive body mass, diabetes, dyslipidemia, hypertension and other cardiometabolic disorders, it is necessary to conduct high-quality research on the development of the most effective cardiac rehabilitation programs, so as to maximize their beneficial effect on patients' health. The aims of the study are: 1. Evaluation of the impact of cardiac rehabilitation on selected anthropometric, biochemical, mineral parameters, body composition parameters, physical fitness parameters and cardiovascular function parameters in patients after acute coronary syndrome. 2. Assessment of lifestyle, acceptance of disease, quality of life, diet and psychological profile and the influence of these factors on the course of cardiac rehabilitation in patients after acute coronary syndrome. 3. Evaluation of the influence of the level of gene expression and polymorphisms of genes associated with ischemic heart disease and predisposing conditions (including excessive body weight, hypertension, lipid and carbohydrate disorders, impaired vascular endothelial function) on the course of cardiac rehabilitation in patients after acute coronary syndrome and searching for new genes that may affect the course of cardiac rehabilitation in this group of patients. Research hypotheses: 1. Cardiac rehabilitation has a positive effect on selected anthropometric, biochemical, mineral parameters, body composition parameters, physical fitness parameters and cardiovascular function parameters in patients after acute coronary syndrome. 2. Lifestyle, acceptance of disease, quality of life, diet and psychological profile have a significant impact on the course of cardiac rehabilitation in patients after acute coronary syndrome. 3. The level of expression and gene polymorphism of genes associated with ischemic heart disease and predisposing conditions (including excessive body weight, hypertension, lipid and carbohydrate disorders, impaired vascular endothelial function) have a significant impact on the course of cardiac rehabilitation in patients after acute coronary syndrome. The study will consist of a retrospective and prospective part. The retrospective part will include patients who have had acute coronary syndrome in the past and then - before being included in the study - have undergone cardiac rehabilitation. In the retrospective part, patients enrolled in the study will not undergo cardiac rehabilitation as a part of the study intervention. In contrast, the prospective part will include patients who have had an acute coronary syndrome in the past and will undergo cardiac rehabilitation as the study intervention. About 200 women and men aged 18 to 99 are planned to be included in the study. After being included in the study, patients will undergo medical examination and their medical documentation will be collected, analyzed, copied and archived. Then subsequent procedures will be performed: * anthropometric measurements (body weight, height, hip, waist, neck circumference measurement) * ECG - electrocardiography * non-invasive analysis of the body composition by bioimpedance * non-invasive measurement of resting blood pressure, resting heart rate and oxygen saturation of hemoglobin * non-invasive pulse wave analysis * non-invasive transthoracic echocardiography of the heart * non-invasive 24-hour blood pressure measurement by ABPM * non-invasive 24-hour ECG recording using the Holter method * non-invasive electrocardiographic exercise test on a treadmill and / or a six-minute walk test or other exercise test adequate to the patient's state of health; these tests will always be preceded by a detailed medical qualification * assessment of the quality of the diet * assessment of lifestyle, acceptance of disease and quality of life * assessment of the psychological profile Subsequently patients taking part in the prospective part of the study will perform a cardiac rehabilitation program. After the cardiac rehabilitation program measurement procedures listed above (anthropometric measurements; ECG; non-invasive analysis of the body composition by bioimpedance; non-invasive measurement of resting blood pressure, resting heart rate and oxygen saturation of hemoglobin; non-invasive pulse wave analysis; non-invasive transthoracic echocardiography of the heart; non-invasive 24-hour blood pressure measurement by ABPM; non-invasive 24-hour ECG recording using the Holter method; non-invasive electrocardiographic exercise test; assessment of the quality of the diet; assessment of lifestyle, acceptance of disease and quality of life; assessment of the psychological profile) will be repeated. Before and after the cardiac rehabilitation program blood samples, urine samples and hair samples will be collected. Blood samples, urine samples and hair samples will also be collected from patients taking part in the retrospective part of the study. After data collection statistical analyses will be performed.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
200
The training program of cardiac rehabilitation, depending on the results of the patient's medical qualification, will consist of the following: free active exercises, isometric exercises, active exercises in relief with resistance, isotonic exercises, isokinetic exercises, active breathing exercises, active breathing exercises with resistance, balance exercises, general exercises- individual and in groups, interval training on a treadmill or cycling cycloergometer, continuous training on a treadmill or cycling cycloergometer, circuit training, walking training, march training with accessories, autogenic training, walking. The training program will last an average 2 weeks.
Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences
Poznan, Wielkopolska, Poland
RECRUITINGPulse wave velocity (PWV) I
Pulse wave velocity I
Time frame: At baseline
PWV II
Pulse wave velocity II
Time frame: After intervention completion- an average of 2 weeks from baseline
Aortic pressure (AP) I
Aortic pressure I
Time frame: At baseline
AP II
Aortic pressure II
Time frame: After intervention completion- an average of 2 weeks from baseline
Body mass (BM) I
Body mass I
Time frame: At baseline
BM II
Body mass II
Time frame: After intervention completion- an average of 2 weeks from baseline
Body height (BH) I
Body height I
Time frame: At baseline
BH II
Body height II
Time frame: After intervention completion- an average of 2 weeks from baseline
Body mass index (BMI) I
Body mass index I
Time frame: At baseline
BMI II
Body mass index II
Time frame: After intervention completion- an average of 2 weeks from baseline
Waist circumference (WC) I
Waist circumference I
Time frame: At baseline
WC II
Waist circumference II
Time frame: After intervention completion- an average of 2 weeks from baseline
Hip circumference (HC) I
Hip circumference I
Time frame: At baseline
HC II
Hip circumference II
Time frame: After intervention completion- an average of 2 weeks from baseline
Neck circumference (NC) I
Neck circumference I
Time frame: At baseline
NC II
Neck circumference II
Time frame: After intervention completion- an average of 2 weeks from baseline
Total fat percentage (TF%) I
Total fat percentage I
Time frame: At baseline
TF% II
Total fat percentage II
Time frame: After intervention completion- an average of 2 weeks from baseline
Systolic blood pressure (SBP) I
Systolic blood pressure I
Time frame: At baseline
SBP II
Systolic blood pressure II
Time frame: After intervention completion- an average of 2 weeks from baseline
Diastolic blood pressure (DBP) I
Diastolic blood pressure I
Time frame: At baseline
DBP II
Diastolic blood pressure II
Time frame: After intervention completion- an average of 2 weeks from baseline
Heart rate (HR) I
Heart rate I
Time frame: At baseline
HR II
Heart rate II
Time frame: After intervention completion- an average of 2 weeks from baseline
Blood oxygen saturation (SO2) I
Blood oxygen saturation I
Time frame: At baseline
SO2 II
Blood oxygen saturation II
Time frame: After intervention completion- an average of 2 weeks from baseline
Ejection fraction (EF) I
Ejection fraction I
Time frame: At baseline
EF II
Ejection fraction II
Time frame: After intervention completion- an average of 2 weeks from baseline
Ambulatory blood pressure monitoring- systolic blood pressure (ABPM SBP) I
Ambulatory blood pressure monitoring- systolic blood pressure I
Time frame: At baseline
ABPM SBP II
Ambulatory blood pressure monitoring- systolic blood pressure II
Time frame: After intervention completion- an average of 2 weeks from baseline
Ambulatory blood pressure monitoring- diastolic blood pressure (ABPM DBP) I
Ambulatory blood pressure monitoring- diastolic blood pressure I
Time frame: At baseline
ABPM DBP II
Ambulatory blood pressure monitoring- diastolic blood pressure II
Time frame: After intervention completion- an average of 2 weeks from baseline
Metabolic equivalent (MET) I
Metabolic equivalent I
Time frame: At baseline
MET II
Metabolic equivalent II
Time frame: After intervention completion- an average of 2 weeks from baseline
Distance in 6-minutes walk (6MW-D) I
Distance in 6-minutes walk I
Time frame: At baseline
6MW-D II
Distance in 6-minutes walk II
Time frame: After intervention completion- an average of 2 weeks from baseline
aspartate aminotransferase (AST) I
Blood concentration of aspartate aminotransferase I
Time frame: At baseline
AST II
Blood concentration of aspartate aminotransferase II
Time frame: After intervention completion- an average of 2 weeks from baseline
alanine aminotransferase (ALT) I
Blood concentration of alanine aminotransferase I
Time frame: At baseline
ALT II
Blood concentration of alanine aminotransferase II
Time frame: After intervention completion- an average of 2 weeks from baseline
total bilirubin (TB) I
Blood concentration of total bilirubin I
Time frame: At baseline
TB II
Blood concentration of total bilirubin II
Time frame: After intervention completion- an average of 2 weeks from baseline
indirect bilirubin (IB) I
Blood concentration of indirect bilirubin I
Time frame: At baseline
IB II
Blood concentration of indirect bilirubin II
Time frame: After intervention completion- an average of 2 weeks from baseline
direct bilirubin (DB) I
Blood concentration of direct bilirubin I
Time frame: At baseline
DB II
Blood concentration of direct bilirubin II
Time frame: After intervention completion- an average of 2 weeks from baseline
gamma-glutamyltransferase (GGTP) I
Blood concentration of gamma-glutamyltransferase I
Time frame: At baseline
GGTP II
Blood concentration of gamma-glutamyltransferase II
Time frame: After intervention completion- an average of 2 weeks from baseline
total cholesterol (TCH) I
Blood concentration of total cholesterol I
Time frame: At baseline
TCH II
Blood concentration of total cholesterol II
Time frame: After intervention completion- an average of 2 weeks from baseline
low density lipoprotein (LDL) I
Blood concentration of low density lipoprotein I
Time frame: At baseline
LDL II
Blood concentration of low density lipoprotein II
Time frame: After intervention completion- an average of 2 weeks from baseline
high density lipoprotein (HDL) I
Blood concentration of high density lipoprotein I
Time frame: At baseline
HDL II
Blood concentration of high density lipoprotein II
Time frame: After intervention completion- an average of 2 weeks from baseline
triglycerides (TG) I
Blood concentration of triglycerides I
Time frame: At baseline
TG II
Blood concentration of triglycerides II
Time frame: After intervention completion- an average of 2 weeks from baseline
apolipoprotein A (ApoA) I
Blood concentration of apolipoprotein A I
Time frame: At baseline
ApoA II
Blood concentration of apolipoprotein A II
Time frame: After intervention completion- an average of 2 weeks from baseline
insulin (INS) I
Blood concentration of insulin I
Time frame: At baseline
INS II
Blood concentration of insulin II
Time frame: After intervention completion- an average of 2 weeks from baseline
glucose (GLU) I
Blood concentration of glucose I
Time frame: At baseline
GLU II
Blood concentration of glucose II
Time frame: After intervention completion- an average of 2 weeks from baseline
creatinine (CREA) I
Blood concentration of creatinine I
Time frame: At baseline
CREA II
Blood concentration of creatinine II
Time frame: After intervention completion- an average of 2 weeks from baseline
C-reactive protein (CRP) I
Blood concentration of C-reactive protein I
Time frame: At baseline
CRP II
Blood concentration of C-reactive protein II
Time frame: After intervention completion- an average of 2 weeks from baseline
adropin (ADR) I
Blood concentration of adropin I
Time frame: At baseline
ADR II
Blood concentration of adropin II
Time frame: After intervention completion- an average of 2 weeks from baseline
neopterin (NEOPT) I
Blood concentration of neopterin I
Time frame: At baseline
NEOPT II
Blood concentration of neopterin II
Time frame: After intervention completion- an average of 2 weeks from baseline
N-terminal natriuretic propeptide type B (NTpro-BNP) I
Blood concentration of N-terminal natriuretic propeptide type B I
Time frame: At baseline
NTpro-BNP II
Blood concentration of N-terminal natriuretic propeptide type B II
Time frame: After intervention completion- an average of 2 weeks from baseline
magnesium (Mg) I
Blood concentration of magnesium I
Time frame: At baseline
Mg II
Blood concentration of magnesium II
Time frame: After intervention completion- an average of 2 weeks from baseline
homocysteine (Hcy) I
Blood concentration of homocysteine I
Time frame: At baseline
Hcy II
Blood concentration of homocysteine II
Time frame: After intervention completion- an average of 2 weeks from baseline
troponin (TROP) I
Blood concentration of troponin I
Time frame: At baseline
TROP II
Blood concentration of troponin II
Time frame: After intervention completion- an average of 2 weeks from baseline
interleukin 6 (IL6) I
Blood concentration of interleukin 6 I
Time frame: At baseline
IL6 II
Blood concentration of interleukin 6 II
Time frame: After intervention completion- an average of 2 weeks from baseline
tumor necrosis factor (TNF) I
Blood concentration of tumor necrosis factor I
Time frame: At baseline
TNF II
Blood concentration of tumor necrosis factor II
Time frame: After intervention completion- an average of 2 weeks from baseline
vascular endothelial growth factor (VEGF) I
Blood concentration of vascular endothelial growth factor I
Time frame: At baseline
VEGF II
Blood concentration of vascular endothelial growth factor II
Time frame: After intervention completion- an average of 2 weeks from baseline
leptin (LPT) I
Blood concentration of leptin I
Time frame: At baseline
LPT II
Blood concentration of leptin II
Time frame: After intervention completion- an average of 2 weeks from baseline
VEGF polymorphism
Polymorphism of the VEGF gene
Time frame: At baseline
Urine concentration of magnesium (U-Mg) I
Urine concentration of magnesium I
Time frame: At baseline
U-Mg II
Urine concentration of magnesium II
Time frame: After intervention completion- an average of 2 weeks from baseline
Hair content of magnesium (H-Mg) I
Hair content of magnesium I
Time frame: At baseline
H-Mg II
Hair content of magnesium II
Time frame: After intervention completion- an average of 2 weeks from baseline
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