SciELO - Scientific Electronic Library Online

 
vol.93 número3Hipertrofia del ventrículo izquierdo detectada en pacientes pediátricos hospitalizados. Un resultado preocupanteCorrigendum - Arch Cardiol Mex. 2023;93(2):172-182 índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Journal

Artigo

Indicadores

Links relacionados

  • Não possue artigos similaresSimilares em SciELO

Compartilhar


Archivos de cardiología de México

versão On-line ISSN 1665-1731versão impressa ISSN 1405-9940

Arch. Cardiol. Méx. vol.93 no.3 Ciudad de México Jul./Set. 2023  Epub 04-Set-2023

https://doi.org/10.24875/acm.22000194 

Opinion article

Changing the paradigm: from cardiac rehabilitation to vascular rehabilitation

Cambiando el paradigma: desde la rehabilitación cardiaca a la rehabilitación vascular

Carlos Escobar1  * 

Raquel Campuzano2 

M. Rosa Fernández3 

Vicente Arrarte4 

Almudena Castro1 

1Department of Cardiology, University Hospital La Paz, Madrid

2Department of Cardiology, University Hospital Fundación Alcorcón, Madrid

3Department of Cardiology, University Hospital of Jaen, Jaen

4Department of Cardiology, University General Hospital, Alicante. Spain


Cardiac rehabilitation, consisting of prescribed exercise and counseling for risk modification, has demonstrated not only to improve risk factors control, but also to reduce recurrent cardiovascular outcomes in patients with previous myocardial infarction. Nevertheless, most patients including in these programs have been limited to patients with prior acute cardiac conditions (i.e., acute coronary syndrome and heart failure)1. However, it should be noted that atherosclerotic vascular disease is not limited to heart disease, but to all vascular beds, including cerebrovascular and peripheral artery disease.

Stroke is a chronic and in many cases disabling condition with a high risk of recurrence (> 10% within the index event). In addition, these patients have a great risk of developing new events in other vascular beds2. Conventionally, the management of these patients has been mainly focused on the acute event and the follow-up on neurological rehabilitation to reduce the stroke-related disability. However, vascular risk factor control after stroke is clearly suboptimal in this population. In fact, more than a half of patients do not attain recommended targets, particularly blood pressure and low-density lipoprotein cholesterol. This is not related with a poor adherence to secondary preventive medication after ischemic stroke, but with an insufficient intensification of vascular protective medications3.

Similarly, patients with peripheral artery disease are at high risk of major atherothrombotic vascular events, including myocardial infarction, ischemic stroke, and vascular-related death, even after revascularization. Thus, it has been reported that one-in-six patients with peripheral artery disease aged ≥ 50 years who underwent peripheral revascularization had a major atherothrombotic vascular event within 1 year4. Remarkably, vascular risk factors control remains far from optimal in this population5. Therefore, all these findings clearly indicate the need for developing new strategies to prevent major vascular events in patients with peripheral artery disease.

In summary, patients with cerebrovascular and peripheral artery disease are at high risk of recurrent events in the same or other vascular beds. This is mainly related with a poor secondary prevention approach. Considering the benefits that has been observed in patients with a previous myocardial infarction after undergoing cardiac rehabilitation programs, it would be desirable that these programs could be extended to patients with previous acute vascular conditions, regardless origin, and not limited to patients with previous acute cardiac conditions. In this context, an urgent change of paradigm is warranted.

References

1. Simon M, Korn K, Cho L, Blackburn GG, Raymond C. Cardiac rehabilitation:a class 1 recommendation. Cleve Clin J Med. 2018;85:551-8. [ Links ]

2. Flach C, Muruet W, Wolfe CD, Bhalla A, Douiri A. Risk and secondary prevention of stroke recurrence:a population-base cohort study. Stroke. 2020;51:2435-44. [ Links ]

3. Gynnild MN, Aakerøy R, Spigset O, Askim T, Beyer MK, Ihle-Hansen H, et al. Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke. J Intern Med. 2021;289:355-68. [ Links ]

4. Desai U, Kharat A, Hess CN, Milentijevic D, LalibertéF, Zuckerman P, et al. Incidence of major atherothrombotic vascular events among patients with peripheral artery disease after revascularization. Ann Vasc Surg. 2021;75:217-26. [ Links ]

5. Song P, Rudan D, Zhu Y, Fowkes FJ, Rahimi K, Fowkes FG, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015:an updated systematic review and analysis. Lancet Glob Health. 2019;7:e1020-30. [ Links ]

FundingNone.

Ethical disclosures

Protection of humans and animals. The authors declare that no experiments on humans or animals have been carried out for this research.

Confidentiality of data. The authors declare that no patient data appear in this article.

Right to privacy and informed consent. The authors declare that no patient data appear in this article.

Received: July 22, 2022; Accepted: November 29, 2022

* Correspondence: Carlos Escobar E-mail: escobar_cervantes_carlos@hotmail.com

Conflicts of interest

None.

Creative Commons License Instituto Nacional de Cardiología Ignacio Chávez. Published by Permanyer. This is an open ccess article under the CC BY-NC-ND license