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Circulation, Vol 89, 975-990, Copyright © 1994 by American Heart Association
WL Haskell, EL Alderman, JM Fair, DJ Maron, SF Mackey, HR Superko, PT Williams, IM Johnstone, MA Champagne and RM Krauss
BACKGROUND: Recent clinical trials have shown that modification of plasma
lipoprotein concentrations can favorably alter progression of coronary
atherosclerosis, but no data exist on the effects of a comprehensive
program of risk reduction involving both changes in lifestyle and
medications. This study tested the hypothesis that intensive multiple risk
factor reduction over 4 years would significantly reduce the rate of
progression of atherosclerosis in the coronary arteries of men and women
compared with subjects randomly assigned to the usual care of their
physician. METHODS AND RESULTS: Three hundred men (n = 259) and women (n =
41) (mean age, 56 +/- 7.4 years) with angiographically defined coronary
atherosclerosis were randomly assigned to usual care (n = 155) or
multifactor risk reduction (n = 145). Patients assigned to risk reduction
were provided individualized programs involving a low-fat and -cholesterol
diet, exercise, weight loss, smoking cessation, and medications to
favorably alter lipoprotein profiles. Computer-assisted quantitative
coronary arteriography was performed at baseline and after 4 years. The
main angiographic outcome was the rate of change in the minimal diameter of
diseased segments. All subjects underwent medical and risk factor
evaluations at baseline and yearly for 4 years, and reasons for all
hospitalizations and deaths were documented. Of the 300 subjects
randomized, 274 (91.3%) completed a follow-up arteriogram, and 246 (82%)
had comparative measurements of segments with visible disease at baseline
and follow-up. Intensive risk reduction resulted in highly significant
improvements in various risk factors, including low-density lipoprotein
cholesterol and apolipoprotein B (both, 22%), high-density lipoprotein
cholesterol (+12%), plasma triglycerides (-20%), body weight (-4%),
exercise capacity (+20%), and intake of dietary fat (- 24%) and cholesterol
(-40%) compared with relatively small changes in the usual-care group. No
change was observed in lipoprotein(a) in either group. The risk-reduction
group showed a rate of narrowing of diseased coronary artery segments that
was 47% less than that for subjects in the usual-care group (change in
minimal diameter, -0.024 +/- 0.066 mm/y versus -0.045 +/- 0.073 mm/y; P
< .02, two-tailed). Three deaths occurred in each group. There were 25
hospitalizations in the risk-reduction group initiated by clinical cardiac
events compared with 44 in the usual-care group (rate ratio, 0.61; P = .05;
95% confidence interval, 0.4 to 0.9). CONCLUSIONS: Intensive multifactor
risk reduction conducted over 4 years favorably altered the rate of luminal
narrowing in coronary arteries of men and women with coronary artery
disease and decreased hospitalizations for clinical cardiac events.
ARTICLES
Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP)
Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA 94304-1583.
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D. Ornish, L. W. Scherwitz, J. H. Billings, K. L. Gould, T. A. Merritt, S. Sparler, W. T. Armstrong, T. A. Ports, R. L. Kirkeeide, C. Hogeboom, et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease JAMA, December 16, 1998; 280(23): 2001 - 2007. [Abstract] [Full Text] [PDF]
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H. Buchwald, R. L. Varco, J. R. Boen, S. E. Williams, B. J. Hansen, C. T. Campos, G. S. Campbell, M. B. Pearce, A. E. Yellin, W. A. Edmiston, et al. Effective Lipid Modification by Partial Ileal Bypass Reduced Long-term Coronary Heart Disease Mortality and Morbidity: Five-Year Posttrial Follow-up Report From the POSCH Arch Intern Med, June 8, 1998; 158(11): 1253 - 1261. [Abstract] [Full Text] [PDF]
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P. S. Gartside, P. Wang, and C. J. Glueck Prospective Assessment of Coronary Heart Disease Risk Factors: The NHANES I Epidemiologic Follow-up Study (NHEFS) 16-Year Follow-up J. Am. Coll. Nutr., June 1, 1998; 17(3): 263 - 269. [Abstract] [Full Text] [PDF]
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J. Niebauer, R. Hambrecht, T. Velich, K. Hauer, C. Marburger, B. Kalberer, C. Weiss, E. von Hodenberg, G. Schlierf, G. Schuler, et al. Attenuated Progression of Coronary Artery Disease After 6 Years of Multifactorial Risk Intervention : Role of Physical Exercise Circulation, October 21, 1997; 96(8): 2534 - 2541. [Abstract] [Full Text]
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M. H. Frick, M. Syvanne, M. S. Nieminen, H. Kauma, S. Majahalme, V. Virtanen, Y. A. Kesaniemi, A. Pasternack, and M.-R. Taskinen Prevention of the Angiographic Progression of Coronary and Vein-Graft Atherosclerosis by Gemfibrozil After Coronary Bypass Surgery in Men With Low Levels of HDL Cholesterol Circulation, October 7, 1997; 96(7): 2137 - 2143. [Abstract] [Full Text]
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H. G. Schrott, V. Bittner, E. Vittinghoff, D. M. Herrington, and S. Hulley Adherence to National Cholesterol Education Program Treatment Goals in Postmenopausal Women With Heart Disease: The Heart and Estrogen/Progestin Replacement Study (HERS) JAMA, April 23, 1997; 277(16): 1281 - 1286. [Abstract] [PDF]
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P. T. Williams, D. M. Dreon, P. J. Blanche, and R. M. Krauss Variability of Plasma HDL Subclass Concentrations in Men and Women Over Time Arterioscler Thromb Vasc Biol, April 1, 1997; 17(4): 702 - 706. [Abstract] [Full Text]
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The Post Coronary Artery Bypass Graft Trial Invest The Effect of Aggressive Lowering of Low-Density Lipoprotein Cholesterol Levels and Low-Dose Anticoagulation on Obstructive Changes in Saphenous-Vein Coronary-Artery Bypass Grafts N. Engl. J. Med., January 16, 1997; 336(3): 153 - 163. [Abstract] [Full Text] [PDF]
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B. D. Miller, E. L. Alderman, W. L. Haskell, J. M. Fair, and R. M. Krauss Predominance of Dense Low-Density Lipoprotein Particles Predicts Angiographic Benefit of Therapy in the Stanford Coronary Risk Intervention Project Circulation, November 1, 1996; 94(9): 2146 - 2153. [Abstract] [Full Text]
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P. S. Tsao, R. Buitrago, J. R. Chan, and J. P. Cooke Fluid Flow Inhibits Endothelial Adhesiveness: Nitric Oxide and Transcriptional Regulation of VCAM-1 Circulation, October 1, 1996; 94(7): 1682 - 1689. [Abstract] [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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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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M. Enriquez-Sarano, E. Klodas, K. N. Garratt, K. R. Bailey, A. J. Tajik, and D. R. Holmes Secular Trends in Coronary Atherosclerosis -- Analysis in Patients with Valvular Regurgitation N. Engl. J. Med., August 1, 1996; 335(5): 316 - 322. [Abstract] [Full Text] [PDF]
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T. R. Pedersen, J. Kjekshus, K. Berg, A. G. Olsson, L. Wilhelmsen, H. Wedel, K. Pyorala, T. Miettinen, T. Haghfelt, O. Færgeman, et al. Cholesterol Lowering and the Use of Healthcare Resources : Results of the Scandinavian Simvastatin Survival Study Circulation, May 15, 1996; 93(10): 1796 - 1802. [Abstract] [Full Text]
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A. A. Kroon, W. R.M. Aengevaeren, T. van der Werf, G. J.H. Uijen, J. H.C. Reiber, A. V.G. Bruschke, and A. F.H. Stalenhoef LDL-Apheresis Atherosclerosis Regression Study (LAARS) : Effect of Aggressive Versus Conventional Lipid Lowering Treatment on Coronary Atherosclerosis Circulation, May 15, 1996; 93(10): 1826 - 1835. [Abstract] [Full Text]
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M. Suurkula, S. Agewall, B. Fagerberg, I. Wendelhag, and J. Wikstrand Multiple Risk Intervention in High-Risk Hypertensive Patients : A 3-Year Ultrasound Study of Intima-Media Thickness and Plaques in the Carotid Artery Arterioscler Thromb Vasc Biol, March 1, 1996; 16(3): 462 - 470. [Abstract] [Full Text]
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M. N. Hill and N. Houston Miller Compliance Enhancement : A Call for Multidisciplinary Team Approaches Circulation, January 1, 1996; 93(1): 4 - 6. [Full Text]
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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. J. Mason, D. K. Owens, R. A. Harris, J. P. Cooke, and M. A. Hlatky The Role of Coronary Angiography and Coronary Revascularization Before Noncardiac Vascular Surgery JAMA, June 28, 1995; 273(24): 1919 - 1925. [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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D. Stokols, K. R. Pelletier, and J. E. Fielding Integration of Medical Care and Worksite Health Promotion JAMA, April 12, 1995; 273(14): 1136 - 1142. [Abstract] [PDF]
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A S Wierzbicki and T M Reynolds Health promotion in general practice BMJ, February 25, 1995; 310(6978): 532c - 533. [Full Text]
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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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