Biomarker-based risk assessment of dietary intervention in patients with coronary artery disease during cardiac rehabilitation: a quasi-experimental study
Background and aimsCardiac rehabilitation (CR) is integral to secondary prevention in coronary artery disease (CAD), incorporating exercise, medical optimization, and dietary interventions. While low-carbohydrate (low-carb) and low-fat diets may improve metabolic health, their comparative impact on...
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| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
23 October 2025
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| In: |
Frontiers in nutrition
Year: 2025, Volume: 12, Pages: 1-15 |
| ISSN: | 2296-861X |
| DOI: | 10.3389/fnut.2025.1669931 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3389/fnut.2025.1669931 Verlag, kostenfrei, Volltext: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1669931/full 
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| Author Notes: | Mona Kotewitsch, Hubert Scharnagl, Dennis Köstler, Marc Teschler, René Garbsch, Hendrik Schäfer, Melina Waranski, Katalin Vereckei, Gereon Böll, Marcus E. Kleber, Alexander Dressel, Winfried März, Boris Schmitz and Frank C. Mooren |
| Summary: | Background and aimsCardiac rehabilitation (CR) is integral to secondary prevention in coronary artery disease (CAD), incorporating exercise, medical optimization, and dietary interventions. While low-carbohydrate (low-carb) and low-fat diets may improve metabolic health, their comparative impact on cardiovascular risk in CR remains unclear. This study assessed the effects of low-carb and low-fat diets on cardiovascular risk, body composition, and major adverse cardiovascular and cerebrovascular events (MACCE) in CAD patients undergoing inpatient CR.MethodsIn this quasi-experimental study, 313 CAD patients (56 ± 7 years, 20% women) participated in CR, adopting a low-carb (n = 58), low-fat (n = 136), or regular diet (n = 119, control). Dietary assignment was non-randomized and based on assisted patient self-selection. A biomarker-based score to estimate the 10-year cardiovascular mortality risk, bioelectrical impedance analysis, and laboratory parameters (HbA1c, lipids, inflammation markers) were assessed at baseline, discharge, and 6-month follow-up. Kaplan-Meier analysis was used to compare MACCE recorded for a mean of 470 ± 293 days.ResultsDuring 3-4 weeks of CR, the 10-year cardiovascular mortality risk decreased by a mean of 3.7 ± 9.6%, with no difference between dietary groups (p = 0.8651). HbA1c improved in the low-carb group during CR compared to the low-fat and regular diet (−4.0 ± 6.6%), but the effect was not significant after adjustments for baseline HbA1c, diabetes prevalence, and medication (p = 0.168). Reductions in BMI, body fat, and visceral fat were recorded in the low-carb and low-fat group, compared to the control group (p ≤ 0.0001). Total cholesterol, LDL, and triglyceride levels also decreased in all groups during CR without significant differences (p ≥ 0.3957). MACCE incidence did not differ between the groups (p = 0.2).ConclusionNo additional immediate benefit in risk reduction during CR for low-carb or low-fat dietary interventions was detected. However, the low-fat and low-carb diet resulted in significantly greater reductions in BMI, body fat and visceral fat, with a tendency towards more stable effects over 6 months in the low-fat group. While glycemic control was improved in the low-carb group during inpatient CR, long-term adherence appeared challenging, particularly for diabetic patients as HbA1c levels re-increased during 6 months follow-up. Since no difference in MACCE was seen, the dietary interventions may be considered equally safe for CAD patients. |
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| Item Description: | Gesehen am 10.12.2025 |
| Physical Description: | Online Resource |
| ISSN: | 2296-861X |
| DOI: | 10.3389/fnut.2025.1669931 |