title: Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review.
abstract: BACKGROUND
  Guidelines for lifestyle and dietary modification in patients with coronary artery disease (CAD) are mainly supported by evidence from general population studies. CAD patients, however, differ from the general population in age (older) and treatment with preventive drugs. This review seeks to provide evidence for a prognostic benefit of lifestyle and dietary recommendations from studies in CAD patients.
  
  
  RESULTS
  A literature search was performed on the effect of lifestyle and dietary changes on mortality in CAD patients. Prospective cohort studies and randomized controlled trials of patients with established CAD were included if they reported all-causes mortality and had at least 6 months of follow-up. The effect estimates of smoking cessation (relative risk [RR], 0.64; 95% CI, 0.58 to 0.71), increased physical activity (RR, 0.76; 95% CI, 0.59 to 0.98), and moderate alcohol use (RR, 0.80; 95% CI, 0.78 to 0.83) were studied most extensively. For the 6 dietary goals, data were too limited to provide reliable effect size estimates. Combinations of dietary changes were associated with reduced mortality (RR, 0.56; 95% CI, 0.42 to 0.74).
  
  
  CONCLUSIONS
  Available studies show convincingly the health benefits of lifestyle changes in CAD patients. Effect estimates of combined dietary changes look promising. Future studies should confirm these findings and assess the contribution of the individual dietary factors.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. j.iestra@umcutrecht.nl
authors.forename: J A
authors.initials: JA
authors.lastname: Iestra
authors.forename: D
authors.initials: D
authors.lastname: Kromhout
authors.forename: Y T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: H C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: W A
authors.initials: WA
authors.lastname: van Staveren
mesh_terms: D002423:Cause of Death; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control*; D004032:Diet; D006801:Humans; D008019:Life Style; D015203:Reproducibility of Results