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Development of new coronary atherosclerotic lesions during a 4-year multifactor risk reduction program: the Stanford
T G Quinn1, E L Alderman, A McMillan
1Division of Cardiovascular Medicine, Stanford University School of Medicine, California.
Objectives:
This study attempted to determine whether an intensive multifactor risk reduction program conducted over 4 years would reduce the rate of development of new coronary artery lesions.
Background:
Recent angiographic trials have generally demonstrated that normalization of plasma lipoprotein profiles reduces the rate of progression of established coronary lesions, but limited data exist on how these treatments influence the development of new lesions.
Methods:
Three hundred men and women with coronary artery disease were randomized to multifactor risk reduction or usual care. Highly significant improvements in risk factors were achieved by the risk reduction group compared with minimal changes by the usual care group. Quantitative coronary angiography was performed on entry and after 4 years under identical conditions. A decrement in the minimal diameter of visually normal segments > 0.2 mm was considered to indicate new lesion formation.
Results:
A total of 1,605 segments, representing 257 patients, were considered normal at baseline, with 804 and 801 disease-free segments in the usual care and risk reduction groups, respectively. Ninety-nine segments (6.1%) were identified by follow-up quantitative angiography and two angiographic observers as having new lesion formation (usual care 7.6%, risk reduction 4.7%, p = 0.05). New lesion formation was observed in 41 (31%) of 131 patients in the usual care group and in 29 (23%) of 126 patients in the risk reduction group (p = 0.16), with a mean number of new lesions/patient of 0.47 in the usual care group and 0.30 in the risk reduction group (p = 0.06). Multiple regression analysis identified on-study dietary fat intake as the best correlate with new lesion formation.
Conclusions:
These data indicate that intensive multifactor risk reduction tends to diminish the frequency of new coronary lesion formation.
Insights
An intensive multifactor risk reduction program over 4 years showed a trend toward reducing new coronary artery lesions. Lower dietary fat intake correlated with less new lesion formation in patients with coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Preventive Cardiology
Background:
- Limited data exist on the impact of treatments on new coronary lesion development.
- Previous trials focused on established lesion progression.
- Lipoprotein profile normalization is known to slow established lesion progression.
Purpose of the Study:
- To determine if a 4-year intensive multifactor risk reduction program reduces new coronary artery lesion development.
- To assess the influence of risk factor modification on de novo coronary lesions.
- To evaluate the efficacy of a comprehensive intervention in preventing new coronary artery disease manifestations.
Main Methods:
- Randomized controlled trial involving 300 patients with coronary artery disease.
- Intervention group received intensive multifactor risk reduction; control group received usual care.
- Quantitative coronary angiography performed at baseline and 4-year follow-up to assess new lesion formation (>0.2 mm diameter decrement in normal segments).
Main Results:
- New lesion formation occurred in 4.7% of segments in the risk reduction group versus 7.6% in the usual care group (p=0.05).
- Fewer patients in the risk reduction group developed new lesions (23% vs. 31%, p=0.16).
- On-study dietary fat intake was the strongest correlate of reduced new lesion formation.
Conclusions:
- Intensive multifactor risk reduction demonstrated a trend towards diminishing new coronary lesion formation.
- These findings suggest that comprehensive risk factor management may impact the development of new coronary lesions.
- Dietary fat intake emerged as a significant factor influencing de novo coronary lesion development.