The Effect of Exercise-Based Cardiac Rehabilitation on Neutrophil to Lymphocyte Ratio in Patients with Coronary Artery Disease

Objective: The effect of exercise-based cardiac rehabilitation (CR) on systemic inflammation was not well established in patients with coronary artery disease (CAD). Neutrophil/lymphocyte (N/L) ratio has emerged as a new inflammation marker and elevated levels were found to be associated with worse clinical outcome in patients with CAD. Also, poor impaired health-related quality of life (HRQL) is an independent predictor of morbi-mortality in patients with CAD. The purpose of this study is to determine the effect of exercise-based CR on N/L ratio and HRQL in patients with CAD.Methods: We enrolled 200 stable CAD out-patients referred for Phase III CR program by their physicians (CR group). We compared them with 100 stable CAD out-patients who did not have access to CR because of travel distance or comorbid conditions that limited exercise (non-CR group).Results: There was not a statistically significant difference in the baseline clinical and biochemical characte-ristics between the groups. Although N/L ratio-post and CRP-post values were lower than the N/L ratio-pre and CRP-pre in CR & non-CR groups (p <0.001 & p: 0.007 and p <0.001 & p <0.001), in the CR group N/L ratio--postand CRP-post values were lower than the non-CR group (p <0.001 & p <0.001 and p <0.001 & p <0.001). Mac-New HRQL total-postscores were higher in the non-CR group (p <0.001).Conclusions: Exercise-based CR program improves N/L ratio values and HRQL in patients with stable CAD. A therapy that improves systemic inflammation is important for good outcome in patients with CAD, there-fore our results may have potentially significant clinical effects.