doi: 10.1161/CIRCULATIONAHA.104.503995
(Circulation. 2005;112:924-934.)
© 2005 American Heart Association, Inc.
Special Report |
Effect Size Estimates of Lifestyle and Dietary Changes on All-Cause Mortality in Coronary Artery Disease Patients
A Systematic Review
From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (J.A.I., Y.T.v.d.S., D.E.G., W.A.v.S.); Nutrition and Consumer Safety Division, RIVM, Bilthoven (D.K.); Division of Nutrition, Wageningen University Research Center, Wageningen (D.K., W.A.v.S.); and Public Health Division, RIVM, Bilthoven (H.C.B.), the Netherlands.
Correspondence to J.A. Iestra, Julius Center for Health Sciences and Primary Care, Department of Nutritional Sciences, University Medical Center Utrecht, PO Box 85500, Room G01.111, 3508 GA Utrecht, The Netherlands. E-mail j.iestra{at}umcutrecht.nl
Received September 1, 2004; revision received February 10, 2005; accepted April 11, 2005.
Background— Guidelines for lifestyle and dietary modification in patients with coronary artery disease (CAD) are mainly supported by evidence from general population studies. CAD patients, however, differ from the general population in age (older) and treatment with preventive drugs. This review seeks to provide evidence for a prognostic benefit of lifestyle and dietary recommendations from studies in CAD patients.
Methods and Results— A literature search was performed on the effect of lifestyle and dietary changes on mortality in CAD patients. Prospective cohort studies and randomized controlled trials of patients with established CAD were included if they reported all-causes mortality and had at least 6 months of follow-up. The effect estimates of smoking cessation (relative risk [RR], 0.64; 95% CI, 0.58 to 0.71), increased physical activity (RR, 0.76; 95% CI, 0.59 to 0.98), and moderate alcohol use (RR, 0.80; 95% CI, 0.78 to 0.83) were studied most extensively. For the 6 dietary goals, data were too limited to provide reliable effect size estimates. Combinations of dietary changes were associated with reduced mortality (RR, 0.56; 95% CI, 0.42 to 0.74).
Conclusions— Available studies show convincingly the health benefits of lifestyle changes in CAD patients. Effect estimates of combined dietary changes look promising. Future studies should confirm these findings and assess the contribution of the individual dietary factors.
Key Words: coronary disease • diet • lifestyle • mortality • patients
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