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).

Abstract

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

Physical Activity Behavior Two to Six Years Following Cardiac Rehabilitation: A Socioecological Analysis

“…Our response rate was 36%. Those who responded were likely more motivated and health conscious than nonresponders 33 ; however, emerging evidence suggests that nonresponse bias may not be a large threat to the generalizability of findings. 34 In comparison to a previous sample of 5922 CR patients at the same center, there were no differences in smoking status, marital status, or the sex ratio of our respondents.…”

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

“…However, the Stanford Coronary Risk Intervention Project, a multifactorial approach of low‐fat diet, smoking cessation, stress management training, and moderate exercise training, reduced cardiovascular event rates in 145 patients of the intervention group by 49% within 4 years of follow‐up. It also led to a slowed progression of atherosclerotic coronary narrowing, with a reduction in coronary lumen diameter by 0.024 mm/y in the target area, whereas a decline of 0.045 mm was evident in the control group (n=155) 96. In the Heidelberg Regression Study, a regression of coronary lesions after 1 year was only evident in patients expending >9228 kJ/wk during exercise.…”

Universal access: But when? Treating the right patient at the right time: Access to cardiac rehabilitation

“…Comprehensive multifactorial rehabilitation and prevention programs have been shown to slow or partially reduce the progression of coronary atherosclerosis (3,4). Meta-analyses of studies performed in the 1970s and 1980s revealed a significant reduction in total and cardiac mortality following participation in CR (5,6).…”