The Effect of Resistance Training on Proprotein Subtilisin Convertase Kexin 9 Level After Coronary Bypass Surgery

The PCSK9 level measured before and after cardiac rehabilitation program (around 3-4 weeks), and compared between two groups. ELISA method will be used to measure plasma PCSK9 level.

Resistance training will be given by professional trainer in gymnasium of National Cardiovascular Center Harapan Kita supervised by cardiologists, following rules from American College of Sports Medicine guideline regarding to exercise after cardiac event.

• resistance training (Behavioral): resistance training consists of lower and upper extremities exercises. We focus on biceps and hamstring to be trained. One session was held for around 30 minutes.
• aerobic training (Behavioral): aerobic exercise consists of warming up session, treadmill exercise (around 20-30 minutes), and wrap-up session (for all session about 1 hour)

Primary outcomes

• PCSK-9 Level [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: this outcome measurement will be achieved by taking patient's blood sample after cardiac rehabilitation program. The method that we use to check PCSK-9 level is ELISA method

Secondary outcomes

• Low Density Lipoprotein [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: this outcome measurement will be achieved by taking patient's blood sample after cardiac rehabilitation program
• Body Mass Index [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: Body Mass Index is calculated by calculating the measured body weight divided by the height square in measure. We take BMI data after cardiac rehabilitation program in every participant.
• High-Density Lipoprotein [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: this outcome measurement will be achieved by taking patient's blood sample after cardiac rehabilitation program
• Total Cholesterol [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: this outcome measurement will be achieved by taking patient's blood sample after cardiac rehabilitation program
• Triglyceride [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: This outcome measurement will be achieved by taking the patient's blood sample after cardiac rehabilitation program
• Fasting Blood Glucose [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: Blood glucose concentration was taken after 10-12-hour fasting. This outcome measurement will be achieved by taking the patient's blood sample after cardiac rehabilitation program
• Systolic Blood Pressure [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: this outcome measurement will be achieved by taking the patient's blood pressure after cardiac rehabilitation program
• Diastolic Blood Pressure [3-4 weeks (after completion of 12 sessions of cardiac rehabilitation program)]: this outcome measurement will be achieved by taking the patient's blood pressure after cardiac rehabilitation program

Sex: All, ages: 18 Years to 70 Years

Inclusion Criteria:

* post elective coronary artery bypass surgery
* > 18 years old
* sign informed consent

Exclusion Criteria:

* contraindications of resistance training (unstable angina, uncontrolled blood pressure (systolic > 160 mmHg diastolic > 100 mmHg), acute heart failure, pulmonary diseases, arrhythmia malignant)
* musculoskeletal pain, visual analog scale >3
* post congenital heart disease surgery
* post elective coronary artery bypass surgery with malfunction valves (operated or not)

Participant flow

Outcome results

• PCSK-9 Level (Primary), Mean, ng/ml: Control Group 377.5 +/- 118.9; Intervention Group 322.53 +/- 107.5
• Low Density Lipoprotein (Secondary), Mean, mg/dL: Control Group 106.3 +/- 26.6; Intervention Group 96.2 +/- 24.9
• Body Mass Index (Secondary), Mean, kg/m^2: Control Group 25.3 +/- 2.9; Intervention Group 24.7 +/- 3.0
• High-Density Lipoprotein (Secondary), Mean, mg/dL: Control Group 36.1 +/- 7.0; Intervention Group 37.4 +/- 7.9
• Total Cholesterol (Secondary), Mean, mg/dL: Control Group 162.2 +/- 32.6; Intervention Group 162.1 +/- 35.5
• Triglyceride (Secondary), Mean, mg/dL: Control Group 145.7 +/- 50.2; Intervention Group 139.4 +/- 50.7
• Fasting Blood Glucose (Secondary), Mean, mg/dL: Control Group 107.7 +/- 24.6; Intervention Group 102.4 +/- 22.9
• Systolic Blood Pressure (Secondary), Mean, mmHg: Control Group 117.3 +/- 11.4; Intervention Group 118.8 +/- 12.5
• Diastolic Blood Pressure (Secondary), Mean, mmHg: Control Group 73.8 +/- 6.3; Intervention Group 74.8 +/- 10.3

Adverse events

Time frame: 2 months

Serious adverse events by term

Other adverse events by term

Limitations and caveats: This study only investigated selected population of patients (post CABG patients) and cannot explain further the mechanism of reduced PCSK9 level by doing resistance training

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• Bambang Dwiputra, MD, Principal investigator, National Cardiovascular Center Harapan Kita