Abstract 1533: Effect of a Long-term Secondary Prevention Program on Progression of Coronary Artery Calcium: A Longitudinal Randomized Controlled Study (The Cetra Study)
Previous studies have shown that CAC increases by 10 –15% per year in asymptomatic subjects, and the attempt to delay or reverse this process by medications have given conflicting results. At present, it is unknown whether CAC progression may be delayed by a secondary prevention program combining exercise training(E)+dietary counseling(D)+medications(M), and whether this intervention may improve the outcome. We prospectively studied 120 patients with documented coronary artery disease (CAD) (99M/21W, age 42– 61 years) who had a previous myocardial infarction and/or coronary artery bypass surgery. Patients were randomized into 2 groups. A group (n=60) underwent the EDM program (E: 3 times a week at home with 16 sessions monitored at the hospital’2 gym twice a year; N: body weigh control every week; M: medications unchanged throughout the study). Group B (n=60) patients were not exercised, but they received nutrition counseling and maintained medications unchanged during the study. Medications were similarly distributed in the 2 groups (A/B: statins 90/88%; BB 82/82%; ACEI 64/66%; ARBs 26/24%;ASA 90/94%; clopidogrel 26/26%). All patients underwent the following examinations on entry and after 14(4) months: blood chemistry, cardiopulmonary exercise testing (CPET), carotid intimal thickness (IMT), brachial artery vasomotor response (BAVR) and CAC score by MDCT.
Results: CAC score (Agatson) was 8% higher than baseline in group A (from 916(890) to 992(901)) and 33% higher in group B (from 946(921) to 1258(1011); P<0.03). Group A had also lower plasma C-reactive protein (P<0.001), LDL-C (P=0.001) and fibrinogen (P=0.038), while white blood cells and IMT were not significantly different (P=0.09 and 0.88, respectively). BAVR was improved in group A (from 4.5(2.5)% to 7.7(2.8)%;P=0.02 vs group B), which was correlated with peakVO2 change (r=0.63, P<0.001). Multivariate analysis selected fibrinogen as the strongest independent predictor of CAC progression (P<0.01). In conclusion, the EDM program is superior to standard therapy to delay the progression of CAC in pts with CAD. This effect seems to be independent of medications, LDL-C, age and level of fitness.