Gender alters the high-density lipoprotein cholesterol response to cardiac rehabilitation.

Purpose: A reduced level of high-density lipoprotein cholesterol (HDL-C) is a powerful independent risk factor for the development and progression of coronary heart disease. This study assessed the effects of cardiac rehabilitation exercise training on HDL-C and other lipid subfractions, giving close attention to the role of gender and baseline values.

Methods: The study population consisted of 340 patients with coronary heart disease who enrolled in outpatient cardiac rehabilitation and completed 36 sessions of exercise over a 12-week period. With the National Cholesterol Education Panel ATP III guidelines used to create categories of HDL-C, patients were stratified at baseline into four subgroups: (1) males with high HDL-C, (2) males with low HDL-C, (3) women with high HDL-C, and (4) women with low HDL-C.

Results: Overall, women experienced a significantly greater improvement in HDL-C after exercise training than men (14% vs 7.1%; P <.0001). Among the patients with a high HDL-C at baseline, the women increased HDL-C by 8.4%, whereas there was no change (0.9%) in the men (P <.001 between groups). Additionally, the women with low HDL-C experienced a significantly greater improvement than the men (15.3% vs 11.5%, P <.03).

Conclusions: The study results demonstrate that women experience a greater improvement in HDL-C with cardiac rehabilitation than men despite similar changes in fitness and body composition. Women, regardless of baseline HDL-C, demonstrated improvements in HDL-C, whereas only men with low HDL-C experienced an increase in HDL-C. These results describe a differing impact of cardiac rehabilitation on changes in HDL-C based on gender. Clinicians should consider the impact of gender when assessing an individual's risk factor goals and therapeutic options.