CLINICAL STUDY: MANAGEMENT OF HYPERCHOLESTEROLEMIA
Combined intense lifestyle and pharmacologic lipid treatment further reduce coronary events and myocardial perfusion abnormalities compared with usual-care cholesterol-lowering drugs in coronary artery disease
Stefano Sdringola, MD, FACC* ,
Keiichi Nakagawa, MD ,
Yuko Nakagawa, MD,
S. Wamique Yusuf, MBBS, MRCP,
Fernando Boccalandro, MD,
Nizar Mullani, BS*,
Mary Haynie, RN, MBA*,
Mary Jane Hess, RN* and
K. Lance Gould, MD, FACC*,*
* Weatherhead P.E.T. Center for Preventing and Reversing Atherosclerosis, Houston, Texas, USA
Department of Medicine, Division of Cardiology, University of Texas Medical School at Houston, Houston, Texas, USA
Third Department of Internal Medicine, Chiba University School of Medicine, Chiba, Japan
Manuscript received January 22, 2002;
revised manuscript received October 1, 2002,
accepted October 10, 2002.
* Reprint requests and correspondence: Dr. K. Lance Gould, The Weatherhead P.E.T. Center, University of Texas Medical School, 6431 Fannin St., Room 4.256 MSB, Houston, Texas 77030, USA.
K.Lance.Gould{at}uth.tmc.edu
OBJECTIVES: The purpose of this study was to determine if combined intense lifestyle and pharmacologic lipid treatment reduce myocardial perfusion abnormalities and coronary events in comparison to usual-care cholesterol-lowering drugs and whether perfusion changes predict outcomes.
BACKGROUND: Lifestyle and lipid drugs separately benefit patients with coronary artery disease (CAD).
METHODS: A total of 409 patients with CAD, who underwent myocardial perfusion imaging by dipyridamole positron emission tomography at baseline and after 2.6 years, had quantitative size/severity of perfusion defects measured objectively by automated software with follow-up for five additional years for coronary artery bypass graft, percutaneous coronary intervention, myocardial infarction, or cardiac death. Patients were categorized blindly according to prospective, predefined criteria as "poor" treatment without diet or lipid drugs, or smoking; "moderate" treatment on American Heart Association diet and lipid-lowering drugs or on strict low-fat diet (<10% of calories) without lipid drugs; and "maximal" treatment with diet <10% of calories as fat, regular exercise, and lipid active drugs dosed to target goals of low-density lipoproteins <2.3 mmol/l (90 mg/dl), high-density lipoproteins >1.2 mmol/l (45 mg/dl), and triglycerides <1.1 mmol/l (100 mg/dl).
RESULTS: Over five years, coronary events occurred in 6.6%, 20.3%, and 30.6% of patients on maximal, moderate, and poor treatment, respectively (p = 0.001). Size/severity of perfusion abnormalities significantly decreased for patients receiving maximal treatment and increased for patients undergoing moderate and poor treatment (p = 0.003 and 0.0001, respectively). Combined intense lifestyle change plus lipid active drugs and severity/change of perfusion abnormalities independently predicted cardiac events.
CONCLUSIONS: Intense lifestyle and pharmacologic lipid treatment reduce size/severity of myocardial perfusion abnormalities and cardiac events compared with usual-care cholesterol-lowering drugs. Perfusion changes parallel treatment intensity and predict outcomes.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass graft | | CAD | | coronary artery disease | | HDL | | high-density lipoproteins | | LDL | | low-density lipoproteins | | LV | | left ventricle | | MI | | myocardial infarction | | PCI | | percutaneous coronary intervention | | PET | | positron emission tomography |
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