{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:59:14Z","timestamp":1787313554595,"version":"build-2736575974"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,5,21]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A retrospective mediation analysis was conducted among 11\u2009196 patients referred to a 12\u2010week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All\u2010cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2\u2010year follow\u2010up (SD, 2.81\u2009years). CR completion was associated with reduced all\u2010cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54\u20130.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40\u20130.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). CR attendance had an indirect effect on all\u2010cause mortality via improved cardiorespiratory fitness (\n                      <jats:italic>ab<\/jats:italic>\n                      =\u22120.006 [95% CI, \u22120.008 to \u22120.003]) and via low\u2010density lipoprotein cholesterol (\n                      <jats:italic>ab<\/jats:italic>\n                      =\u22120.002 [95% CI, \u22120.003 to \u22120.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (\n                      <jats:italic>ab<\/jats:italic>\n                      =\u22120.007 [95% CI, \u22120.012 to \u22120.003]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.033568","type":"journal-article","created":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T06:27:43Z","timestamp":1716013663000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A\u00a0Retrospective Cohort Study"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7090-8864","authenticated-orcid":false,"given":"Codie R.","family":"Rouleau","sequence":"first","affiliation":[{"name":"TotalCardiology Research Network Calgary Alberta Canada"},{"name":"Department of Psychology University of Calgary Calgary Alberta Canada"},{"name":"Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Chirico","sequence":"additional","affiliation":[{"name":"TotalCardiology Research Network Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6344-312X","authenticated-orcid":false,"given":"Stephen B.","family":"Wilton","sequence":"additional","affiliation":[{"name":"TotalCardiology Research Network Calgary Alberta Canada"},{"name":"Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8178-3235","authenticated-orcid":false,"given":"Matthew K.","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1807-8227","authenticated-orcid":false,"given":"Tianqi","family":"Tao","sequence":"additional","affiliation":[{"name":"Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6675-1996","authenticated-orcid":false,"given":"Ross","family":"Arena","sequence":"additional","affiliation":[{"name":"TotalCardiology Research Network Calgary Alberta Canada"},{"name":"Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2056-9870","authenticated-orcid":false,"given":"Tavis","family":"Campbell","sequence":"additional","affiliation":[{"name":"TotalCardiology Research Network Calgary Alberta Canada"},{"name":"Department of Psychology University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6901-7124","authenticated-orcid":false,"given":"Sandeep","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"TotalCardiology Research Network Calgary Alberta Canada"},{"name":"Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","article-title":"Exercise\u2010based cardiac rehabilitation for coronary heart disease (review)","volume":"11","author":"Dibben G","year":"2021","unstructured":"Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. 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