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Progression of atherosclerosis in middle-aged men: effects of multifactorial intervention
J Persson1, B Israelsson, L Stavenow
1Department of Medicine, Lund University, University Hospital, Malmö, Sweden.
Insights
A 2-year multifactorial intervention successfully reduced cardiovascular risk factors like smoking and blood lipids in healthy men. However, it did not significantly alter atherosclerosis progression as measured by ultrasound. Further research into more aggressive interventions is suggested.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Medical Imaging
Background:
- Cardiovascular disease remains a leading cause of mortality.
- Atherosclerosis, a key contributor, is influenced by modifiable risk factors.
- Early detection and intervention are crucial for managing cardiovascular health.
Purpose of the Study:
- To evaluate the impact of a multifactorial intervention on atherosclerosis progression in healthy middle-aged men.
- To assess changes in carotid artery intima-media thickness and plaque score.
- To determine if risk factor modification influences subclinical atherosclerosis.
Main Methods:
- A 2-year randomized controlled trial involving 149 healthy middle-aged men with moderately increased cardiovascular risk.
- Intervention group received multifactorial lifestyle advice (smoking cessation, lipid and blood pressure reduction).
- Ultrasound assessment of carotid artery intima-media thickness and plaque score, alongside blood lipid and blood pressure measurements.
Main Results:
- The intervention group showed significant reductions in smoking, blood lipids, and blood pressure.
- Despite risk factor improvements, both intervention and control groups exhibited significant increases in intima-media thickness and plaque scores.
- No significant differences in ultrasound-determined atherosclerosis progression were observed between the groups.
Conclusions:
- A 2-year multifactorial intervention focusing on lifestyle changes did not halt or reverse atherosclerosis progression in this cohort.
- More intensive or pharmacologically-driven interventions may be necessary to impact subclinical atherosclerosis.
- Further studies are warranted to explore optimal strategies for preventing cardiovascular disease progression.
Objective:
To determine the effect of multifactorial intervention against cardiovascular risk factors on ultrasound-determined progression of atherosclerosis in healthy middle-aged men.
Design:
One hundred and forty-nine healthy middle-aged men were assigned to an intervention group (IG) or a control group (CG).
Subjects:
The participants had moderately increased risk-factor scores for cardiovascular disease. They were recruited from a health screening programme at the Preventive Medicine Section, Department of Medicine, Lund University, University Hospital, Malmö. During the study period, 32 of the subjects were lost to follow-up, leaving 59 in the IG and 58 in the CG.
Intervention:
The IG subjects underwent multifactorial intervention for 2 years, the goal being to help them stop smoking and to reduce their blood lipids and blood pressure.
Main Outcome Measures:
Intima-media thickness and plaque score in the right carotid artery were ultrasonographically determined initially and after 2 years. Blood lipids and blood pressure were measured at the same time, and in the IG also after 3, 6, 12 and 18 months after entry into the study.
Results:
At the entry into the study, there were no significant differences in major risk factors or ultrasound variables between IG and CG. Blood lipids and smoking decreased significantly during the 2 years of intervention in the IG, whilst these factors remained unchanged in the CG. Intima-media thickness and plaque scores increased significantly in both groups.
Conclusions:
No effects on ultrasound variables could be detected after 2 years of multifactorial intervention. A more aggressive intervention programme, possibly more dependent on pharmacological treatment, may be required to obtain reduced progression or regression of atherosclerosis.