The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM. 1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO2 peak), body mass index, resting systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression. 430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO2 peak. 12-month cardiac mortality was higher in patients with DM. While immediate improvements in VO2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short- and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR. Trial registration NTR5306 at trialregister.nl; trial registered 07/16/2015; https://www.trialregister.nl/trial/5166

中文翻译：

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有和没有糖尿病的老年患者心脏康复后的临床结局：EU-CaRE多中心队列研究。

伴随心血管疾病和糖尿病（DM）的患者患病率迅速增加。我们的目的是比较七个欧洲国家中有或没有DM的老年心脏病患者当前的心脏康复（CR）计划的有效性。纳入了1633例急慢性冠状动脉疾病（CAD）患者和瓣膜介入治疗后年龄在65岁或以上的患者，他们参加了全面的CR（3周至3个月，具体取决于中心）。在CR开始之前，CR终止时（可变时间点）评估了峰值摄氧量（VO2峰值），体重指数，静息收缩压，低密度脂蛋白胆固醇（LDL-C）和糖化血红蛋白（HbA1c）。 ），以及开始CR后的12个月，CR后无需干预。使用混合模型比较了有和没有DM的患者的基线值和从基线到12个月随访的变化，并使用logistic回归比较了死亡率和住院率。430名（26.3％）患者患有糖尿病。DM患者的体脂更多，教育程度较低，合并症，心血管危险因素和CAD更高。两组在研究期间均增加了VO2峰值，但对DM患者从基线到随访的改善显着降低。在DM组中，HbA1c的变化与体重的变化有关，但与绝对VO2峰值的变化无关。DM患者的12个月心脏死亡率更高。尽管有和没有DM的老年患者CR后VO2峰值的立即改善相似，DM患者维持这种改善的12个月较差，可能与疾病进展有关。在短期和长期需要胰岛素的糖尿病患者中，血糖控制较差。由于血糖控制仅与体重减轻有关，而与运动能力的增加无关，因此这突出了肥胖的DM患者在CR期间体重减轻的重要性。在Trialregister.nl上注册NTR5306的试用版；试用注册时间：07/16/2015；https://www.trialregister.nl/trial/5166 在Trialregister.nl上注册NTR5306的试用版；试用注册时间：07/16/2015；https://www.trialregister.nl/trial/5166 在Trialregister.nl上注册NTR5306的试用版；试用注册时间：07/16/2015；https://www.trialregister.nl/trial/5166