Effects of different exercise interventions on lipid profiles in patients with stable coronary artery disease: a systematic review and network meta-analysis

INTRODUCTION: Stable coronary artery disease (SCAD) is frequently accompanied by dyslipidemia, and residual lipid abnormalities persist despite pharmacological therapy. Exercise training has been shown to improve lipid metabolism, but the comparative efficacy of different exercise modalities remains unclear. EVIDENCE ACQUISITION: We conducted a PRISMA-based network meta-analysis including randomized controlled trials (RCTs) that evaluated exercise interventions in patients with stable coronary artery disease and reported lipid-related outcomes. Risk of bias (RoB 2.0) and GRADE were applied. Pairwise and network meta-analyses estimated effects, with SUCRA rankings, consistency, and publication bias assessments. EVIDENCE SYNTHESIS: Twenty randomized controlled trials (RCTs; N.=2314) were included. Combined aerobic and resistance exercise (CAREX) produced the most pronounced reductions in total cholesterol (TC) (MD=-0.88, 95% CrI -1.36 to -0.37) and triglycerides (TG) (MD=-0.49, 95% CrI -0.74 to -0.23), and outperformed continuous aerobic exercise (CAE) in both outcomes. High-intensity interval training (HIIT) and CAE also significantly reduced TG. Mind-body exercise (MBE) and CAREX significantly increased high-density lipoprotein cholesterol (HDL-C) (MD=0.16, 95% CrI 0.04-0.26; MD=0.11, 95% CrI 0.01-0.22, respectively), with mind-body exercise (MBE) ranked highest for this outcome. No exercise modality significantly improved LDL-C. Certainty of evidence was rated as moderate for HDL-C and TG, and low for TC and LDL-C. CONCLUSIONS: CAREX is most effective for lowering TC and TG, while MBE optimally raises HDL-C. Exercise has limited effects on LDL-C, likely due to statin therapy. CAREX and MBE may be prioritized in secondary prevention for SCAD.