Circulation, Vol 86, 1-11, Copyright © 1992 by American Heart Association
G Schuler, R Hambrecht, G Schlierf, J Niebauer, K Hauer, J Neumann, E Hoberg, A Drinkmann, F Bacher and M Grunze
BACKGROUND. Significant regression of coronary and femoral atherosclerotic
lesions has been documented by angiographic studies using aggressive
lipid-lowering treatment. This study tested the applicability and effects
of intensive physical exercise and low-fat diet on coronary morphology and
myocardial perfusion in nonselected patients with stable angina pectoris.
METHODS AND RESULTS. Patients were recruited after routine coronary
angiography for stable angina pectoris; they were randomized to an
intervention group (n = 56) and a control group on "usual care" (n = 57).
Treatment comprised intensive physical exercise in group training sessions
(minimum, 2 hr/wk), daily home exercise periods (20 min/d), and low-fat,
low-cholesterol diet (American Heart Association recommendation, phase 3).
No lipid-lowering agents were prescribed. After 12 months of participation,
repeat coronary angiography was performed; relative and minimal diameter
reductions of coronary lesions were measured by digital image processing.
Change in myocardial perfusion was assessed by 201Tl scintigraphy. In
patients participating in the intervention group, body weight decreased by
5% (p less than 0.001), total cholesterol by 10% (p less than 0.001), and
triglycerides by 24% (p less than 0.001); high density lipoproteins
increased by 3% (p = NS). Physical work capacity improved by 23% (p less
than 0.0001), and myocardial oxygen consumption, as estimated from maximal
rate-pressure product, by 10% (p less than 0.05). Stress-induced myocardial
ischemia decreased concurrently, indicating improvement of myocardial
perfusion. Based on minimal lesion diameter, progression of coronary
lesions was noted in nine patients (23%), no change in 18 patients (45%),
and regression in 13 patients (32%). In the control group, metabolic and
hemodynamic variables remained essentially unchanged, whereas progression
of coronary lesions was noted in 25 patients (48%), no change in 18
patients (35%), and regression in nine patients (17%). These changes were
significantly different from the intervention group (p less than 0.05).
CONCLUSIONS. In patients participating in regular physical exercise and
low-fat diet, coronary artery disease progresses at a slower pace compared
with a control group on usual care.
ARTICLES
Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease
Department of Cardiology, Medizinische Universitatsklinik, Heidelberg, Germany.
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