(Circulation. 1997;96:2534-2541.)
© 1997 American Heart Association, Inc.
Articles |
Attenuated Progression of Coronary Artery Disease After 6 Years of Multifactorial Risk Intervention
Role of Physical Exercise
From Medizinische Universitätsklinik Heidelberg, Abteilung Innere Medizin III–Kardiologie (J.N., T.V., K.H., C.M., B.K., C.W., G. Schlierf, R.Z., W.K.), Heidelberg, Germany; Herzzentrum der Universität Leipzig (R.H., G. Schuler), Abteilung Innere Medizin–Kardiologie, Leipzig, Germany; and Herzzentrum Lahr (E. von H.), Abteilung Kardiologie, Lahr, Germany.
Correspondence to Josef Niebauer, MD, Cardiac Medicine, National Heart and Lung Institute, Imperial College School of Medicine, Dovehouse St, London SW3 6LY, UK. E-mail j.niebauer{at}ic.ac.uk
Background It was the aim of this study to assess the long-term effects of physical exercise and low-fat diet on the progression of coronary artery disease. At the beginning of the study, 113 male patients with coronary artery disease were randomized to an intervention group (n=56) or a control group (n=57); 90 patients (80%) could be reevaluated after 6 years.
Methods and Results Patients in the intervention group (n=40)
showed a reduction in total serum cholesterol (6.03±1.03
versus 5.67±1.01 mmol/L; P<.03) and
triglyceride levels (1.94±0.8 versus 1.6±0.89
mmol/L; P<.005) and maintained their initial body mass
index (26±2 versus 27±2 kg/m2; P=NS), but
results were not statistically different from the control group (n=50)
(total serum cholesterol, 6.05±1.02 versus 5.79±0.88
mmol/L; triglycerides, 2.25±1.28 versus 1.85±0.96
mmol/L [both P=NS]; body mass index, 26±2 versus
28±3 kg/m2 [P<.0001]). In the
intervention group, there was a significant 28% increase in physical
work capacity (166±59 versus 212±89 W; P<.001),
whereas values remained essentially unchanged in the control group
(165±51 versus 170±60 W; P=NS; between groups,
P<.05). In the intervention group, coronary
stenoses progressed at a significantly slower rate than in the
control group (P<.0001). Energy expenditure during
exercise was assessed in a subgroup; patients with regression of
coronary stenoses spent an average of 1784±384 kcal/wk
(
4 hours of moderate aerobic exercise per week).
Multivariate regression analysis identified
only physical work capacity as independently contributing to
angiographic changes.
Conclusions After 6 years of multifactorial risk intervention, there is significant and persistent improvement in lipoprotein levels and physical work capacity, which results in a significant retardation of disease progression. These beneficial effects appear to be largely due to chronic physical exercise.
Key Words: prevention • exercise • angiography • diet • atherosclerosis
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