Attenuated Progression of Coronary Artery Disease After 6 Years of Multifactorial Risk Intervention

Abstract

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/m ² ; 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/m ² [ 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.