Gender Alters the High-density Lipoprotein Cholesterol Response to Cardiac Rehabilitation

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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.


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.


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).


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.

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