Biomarker-based risk assessment of dietary intervention in patients with coronary artery disease during cardiac rehabilitation-a quasi-experimental study.

Background and aims: Cardiac 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. Methods: In this quasi-experimental study, 313 CAD patients (56 ± 7 years, 20% women) participated in CR, adopting a low-carb ( Results: During 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 ( Conclusion: No 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.