title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: Weatherhead P.E.T. Center for Preventing and Reversing Atherosclerosis, Houston, Texas, USA.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sdringola
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: S Wamique
authors.initials: SW
authors.lastname: Yusuf
authors.forename: Fernando
authors.initials: F
authors.lastname: Boccalandro
authors.forename: Nizar
authors.initials: N
authors.lastname: Mullani
authors.forename: Mary
authors.initials: M
authors.lastname: Haynie
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Hess
authors.forename: K Lance
authors.initials: KL
authors.lastname: Gould
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D018752:Diet, Fat-Restricted; D004176:Dipyridamole; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014055:Tomography, Emission-Computed; D015431:Weight Loss
chemical_list: D000960:Hypolipidemic Agents; D004176:Dipyridamole