Intensive lifestyle changes for reversal of coronary heart disease
Intensive lifestyle changes for reversal of coronary heart disease
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DOI：
10.1001/jama.280.23.2001
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发表时间：
1998-12-16
影响因子：
120.7
通讯作者：
Brand, RJ
中科院分区：
文献类型：
--
作者：
Ornish, D;Scherwitz, LW;Brand, RJ
背景。-生活方式心脏试验表明，密集的生活方式的改变可能会导致冠状动脉粥样硬化消退后1年。确定患者持续5年强化生活方式改变的可行性以及这些生活方式改变（无降脂药物）对冠心病的影响。1986年至1992年采用随机邀请设计进行的随机对照试验。48例中重度冠心病患者被随机分配到强化生活方式改变组或常规护理对照组，35例完成了5年随访定量冠状动脉造影。两个三级护理大学医疗中心。干预。强化生活方式的改变（10%脂肪全食物素食，有氧运动，压力管理训练，戒烟，团体心理社会支持）5年。坚持强化生活方式的改变，冠状动脉直径狭窄百分比的变化和心脏事件。实验组患者（28例患者中有20例[71%]完成了E1年随访）进行了全面的生活方式改变并维持了5年，而对照组患者（20例患者中有15例[75%]完成了5年随访）进行了更温和的改变。在实验组中，基线时的平均直径狭窄百分比在1年后下降了1.75个绝对百分点（相对改善4.5%），在5年后下降了3.1个绝对百分点（相对改善7.9%）。相比之下，对照组的平均直径狭窄百分比在1年后增加了2.3个百分点（相对恶化5.4%），在5年后增加了11.8个百分点（相对恶化27.7%）（两组间P= 0.001）。在5年随访期间，28名实验组患者发生25起心脏事件，20名对照组患者发生45起事件（对照组任何事件的风险比为2.47 [95%置信区间为1.48-4.20]）。实验组5年后冠状动脉粥样硬化的消退比1年后多。相比之下，在对照组中，冠状动脉粥样硬化继续进展，心脏事件的发生率是对照组的两倍多。
Context.-The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year.Objectives.-To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease.Design.-Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design.Patients.-Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography,Setting.-Two tertiary care university medical centers.Intervention.-Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years.Main Outcome Measures.-Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events.Results.-Experimental group patients (20 [71%] of 28 patients completed Ei-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]).Conclusions.-More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.