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)
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)
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DOI：
10.1161/01.cir.89.3.975
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发表时间：
1994-03-01
期刊：
影响因子：
37.8
通讯作者：
FARQUHAR, JW
中科院分区：
文献类型：
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作者：
HASKELL, WL;ALDERMAN, EL;FARQUHAR, JW
背景：最近的临床试验表明，改变血浆脂蛋白浓度可以有利地改变冠状动脉粥样硬化的进展，但目前还没有关于改变生活方式和药物治疗的综合降低风险计划的效果的数据。这项研究验证了这样的假设，即与随机分配到常规体检的受试者相比，在4年内强化多种危险因素的减少将显著降低男性和女性冠状动脉粥样硬化的进展速度。方法和结果300名男性(n=259)和女性(n=41)(平均年龄56+/-7.4岁)被随机分配到常规护理组(n=155)或多因素降低风险组(n=145)。被分配到降低风险的患者被提供了个性化的计划，包括低脂肪和低胆固醇饮食、锻炼、减肥、戒烟和有利于改变脂蛋白谱的药物。在基线和4年后进行计算机辅助定量冠状动脉造影术。主要的血管造影结果是病变节段最小直径的变化率。所有受试者在基线和4年内每年接受医学和危险因素评估，并记录所有住院和死亡的原因。在300名随机受试者中，274人(91.3%)完成了随访动脉造影，246人(82%)在基线和随访时对可见疾病的节段进行了比较测量。密集的风险降低导致各种风险因素的高度显著改善，包括低密度脂蛋白胆固醇和载脂蛋白B(均为22%)、高密度脂蛋白胆固醇(+12%)、血浆甘油三酯(-20%)、体重(-4%)、运动能力(+20%)以及饮食脂肪(-24%)和胆固醇(-40%)的摄入量，而常规护理组的变化相对较小。两组均未观察到脂蛋白(A)的变化。降低风险组病变冠状动脉节段狭窄率比常规护理组低47%(最小管径变化，-0.024±-0.066 mm/y比-0.045+/-0.073 mm/y；P
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 yearly for 4 years, and reasons for all hospitalizations and deaths were documented. Of the 300 subjects randomized, 274 (91.3%) completed a follow-up arteriogram, and 246 (82%) had comparative measurements of segments with visible disease at baseline and follow-up. Intensive risk reduction resulted in highly significant improvements in various risk factors, including low-density lipoprotein cholesterol and apolipoprotein B (both, 22%), high-density lipoprotein cholesterol (+12%), plasma triglycerides (-20%), body weight (-4%), exercise capacity (+20%), and intake of dietary fat (-24%) and cholesterol (-40%) compared with relatively small changes in the usual-care group. No change was observed in lipoprotein(a) in either group. The risk-reduction group showed a rate of narrowing of diseased coronary artery segments that was 47% less than that for subjects in the usual-care group (change in minimal diameter, -0.024+/-0.066 mm/y versus -0.045+/-0.073 mm/y; P