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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F. K. Welty, M. A. Mittleman, P. W.F. Wilson, P. A. Sutherland, T. H. Matheney, I. Lipinska, J. E. Muller, D. Levy, and G. H. Tofler Hypobetalipoproteinemia Is Associated With Low Levels of Hemostatic Risk Factors in the Framingham Offspring Population Circulation, February 18, 1997; 95(4): 825 - 830. [Abstract] [Full Text]
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D. A. McCarron, S. Oparil, A. Chait, R. B. Haynes, P. Kris-Etherton, J. S. Stern, L. M. Resnick, S. Clark, C. D. Morris, D. C. Hatton, et al. Nutritional Management of Cardiovascular Risk Factors: A Randomized Clinical Trial Arch Intern Med, January 27, 1997; 157(2): 169 - 177. [Abstract] [PDF]
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S. T. Weiss Cardiovascular Effects of Environmental Tobacco Smoke Circulation, August 15, 1996; 94(4): 599 - 599. [Full Text]
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D. Waters, J. Lesperance, P. Gladstone, S. J. Boccuzzi, T. Cook, R. Hudgin, G. Krip, and L. Higginson Effects of Cigarette Smoking on the Angiographic Evolution of Coronary Atherosclerosis: A Canadian Coronary Atherosclerosis Intervention Trial (CCAIT) Substudy Circulation, August 15, 1996; 94(4): 614 - 621. [Abstract] [Full Text]
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K. Steenland, M. Thun, C. Lally, and C. Heath Environmental Tobacco Smoke and Coronary Heart Disease in the American Cancer Society CPS-II Cohort Circulation, August 15, 1996; 94(4): 622 - 628. [Abstract] [Full Text]
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G. F. Fletcher, G. Balady, S. N. Blair, J. Blumenthal, C. Caspersen, B. Chaitman, S. Epstein, E. S. S. Froelicher, V. F. Froelicher, I. L. Pina, et al. Statement on Exercise: Benefits and Recommendations for Physical Activity Programs for All Americans: A Statement for Health Professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association Circulation, August 15, 1996; 94(4): 857 - 862. [Full Text]
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J. Wouter Jukema, A. J. van Boven, A. H. Zwinderman, E. T. Bal, J. H. C. Reiber, and A. V. G. Bruschke The Influence of Angiographic Endpoints on the Outcome of Lipid Intervention Studies: A Proposal for Standardization Angiology, July 1, 1996; 47(7): 633 - 642. [Abstract] [PDF]
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J. Bogousslavsky, S. Garazi, X. Jeanrenaud, N. Aebischer, G. Van Melle, and For the Lausanne Stroke with Paradoxal Embolism St Stroke recurrence in patients with patent foramen ovale: The Lausanne Study Neurology, May 1, 1996; 46(5): 1301 - 1301. [Abstract] [Full Text] [PDF]
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R. R. Makkar, N. Eigler, F. Litvack, and J. S. Forrester Prevention of Restenosis by Local Drug Delivery Journal of Cardiovascular Pharmacology and Therapeutics, April 1, 1996; 1(2): 177 - 188. [Abstract] [PDF]
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W. D. Weaver, H. D. White, R. G. Wilcox, P. E. Aylward, D. Morris, A. Guerci, E. M. Ohman, G. I. Barbash, A. Betriu, Z. Sadowski, et al. Comparisons of Characteristics and Outcomes Among Women and Men With Acute Myocardial Infarction Treated With Thrombolytic Therapy JAMA, March 13, 1996; 275(10): 777 - 782. [Abstract] [PDF]
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L. Lacoste, J. Y.T. Lam, J. Hung, G. Letchacovski, C. B. Solymoss, and D. Waters Hyperlipidemia and Coronary Disease : Correction of the Increased Thrombogenic Potential With Cholesterol Reduction Circulation, December 1, 1995; 92(11): 3172 - 3177. [Abstract] [Full Text]
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D. Waters, L. Higginson, P. Gladstone, S. J. Boccuzzi, T. Cook, and J. Lesperance Effects of Cholesterol Lowering on the Progression of Coronary Atherosclerosis in Women : A Canadian Coronary Atherosclerosis Intervention Trial (CCAIT) Substudy Circulation, November 1, 1995; 92(9): 2404 - 2410. [Abstract] [Full Text]
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K. L. Gould, D. Ornish, L. Scherwitz, S. Brown, R. P. Edens, M. J. Hess, N. Mullani, L. Bolomey, F. Dobbs, W. T. Armstrong, et al. Changes in Myocardial Perfusion Abnormalities by Positron Emission Tomography After Long-term, Intense Risk Factor Modification JAMA, September 20, 1995; 274(11): 894 - 901. [Abstract] [PDF]
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J. N Wight Jr and D. Salem Sudden Cardiac Death and the `Athlete's Heart' Arch Intern Med, July 24, 1995; 155(14): 1473 - 1480. [Abstract] [PDF]
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R. R. Wing, R. W. Jeffery, and W. L. Hellerstedt A Prospective Study of Effects of Weight Cycling on Cardiovascular Risk Factors Arch Intern Med, July 10, 1995; 155(13): 1416 - 1422. [Abstract] [PDF]
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J. W. Jukema, A. V.G. Bruschke, A. J. van Boven, J. H.C. Reiber, E. T. Bal, A. H. Zwinderman, H. Jansen, G. J.M. Boerma, F. M. van Rappard, and K. I. Lie Effects of Lipid Lowering by Pravastatin on Progression and Regression of Coronary Artery Disease in Symptomatic Men With Normal to Moderately Elevated Serum Cholesterol Levels : The Regression Growth Evaluation Statin Study (REGRESS) Circulation, May 15, 1995; 91(10): 2528 - 2540. [Abstract] [Full Text]
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M. J. Perko, M. Norgaard, T. M. Herzog, P. S. Olsen, T. V. Schroeder, and G. Pettersson Unoperated Aortic Aneurysm: A Survey of 170 Patients Ann. Thorac. Surg., May 1, 1995; 59(5): 1204 - 1209. [Abstract] [Full Text]
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S. A. Glantz and W. W. Parmley Passive Smoking and Heart Disease: Mechanisms and Risk JAMA, April 5, 1995; 273(13): 1047 - 1053. [Abstract] [PDF]
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G. N. Levine, J. F. Keaney, and J. A. Vita Cholesterol Reduction in Cardiovascular Disease -- Clinical Benefits and Possible Mechanisms N. Engl. J. Med., February 23, 1995; 332(8): 512 - 521. [Full Text] [PDF]
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M. J. Cowan Measurement of Heart Rate Variability West J Nurs Res, February 1, 1995; 17(1): 32 - 48. [Abstract] [PDF]
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N. D. Barnard, A. Akhtar, and A. Nicholson Factors That Facilitate Compliance to Lower Fat Intake Arch Fam Med, February 1, 1995; 4(2): 153 - 158. [Abstract] [PDF]
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H. B. Simon Patient-Directed, Nonprescription Approaches to Cardiovascular Disease Arch Intern Med, October 24, 1994; 154(20): 2283 - 2296. [Abstract] [PDF]
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