Effects of cardiac rehabilitation after myocardial infarction: changes in coronary risk factors and long-term prognosis.

Prognosis during 5 years of follow-up after first myocardial infarction (MI) in a group of men (aged 40 to 55 years) was related to risk factors determined at the time of MI. Progression of coronary artery disease (CAD) was measured by the occurrence of severe angina pectoris, recurrent myocardial infarction, and cardiac death. Only smoking and serum cholesterol level influenced prognosis. It was possible to identify a subgroup (patients smoking less than 20 cigarettes/day and having a cholesterol level of less than 7.0 mmoles/L) with low risk for progression of CAD. A randomly applied 6-week rehabilitation program shortly after MI was associated with a 50% decrease in progressive CAD when compared to the control group. Since only a slight decrease in cholesterol levels was found in the rehabilitation group, a direct effect of the rehabilitation program could thus not be excluded because the second important risk factor, smoking, did not show differences between the two groups. The smoking habits at the time of MI determined the continuation of cigarette smoking and rehabilitation did not influence smoking habits.