Effects of lifestyle modification on the progression of coronary atherosclerosis, autonomic function, and angina--the role of GNB3 C825T polymorphism.
BACKGROUND
Given the multimodal medical and interventional treatment options in coronary artery disease, the additional value of intensified lifestyle modification is unclear. We have therefore examined the effects of lifestyle modification on top of current treatment and also associated with the GNB3 C825T polymorphism, which has established association to sympathetic activation and the precipitation of angina.


METHODS
One hundred one patients with established coronary artery disease were randomized to a 1-year lifestyle modification group (lifestyle group [LG]) or an advice group. Risk factors, coronary calcification (electron beam tomography), heart rate variability, baroreflex sensitivity, anginal symptoms, and quality of life (QOL) were assessed on entry and after 1 year.


RESULTS
Patients in LG had excellent program adherence, but lifestyle modification had no impact on metabolic risk factors and coronary calcification. Changes in heart rate, heart rate variability, and blood pressure were only slightly favoring LG. Baroreflex sensitivity increased by 2 (0.79-3.13) ms/mm Hg in the LG but decreased by -0.10 (-1.11 to 0.92) in the advice group (P = .013). Lifestyle modification led to improved physical QOL, reductions of anginal attacks (-54% vs 11%, P = .01), and dose reductions in 30% of anti-ischemic medications (P = .004). *825T allele carriers had a more pronounced reduction of heart rate and improvement of angina and QOL. The beneficial effect on reduction of medication was seen in *825T allele carriers only.


CONCLUSIONS
In the presence of modern treatments, comprehensive lifestyle modification provides no additional benefits on progression of atherosclerosis but improves autonomic function, angina, and QOL with concomitant reduced need of medication. These responses are more pronounced in GNB3*825T allele carriers.
Michalsen
Andreas
A
Abteilung Innere Medizin V, Kliniken-Essen-Mitte, Germany. andreas.michalsen@uni-essen.de
Knoblauch
Nicola T M
NT
Lehmann
Nils
N
Grossman
Paul
P
Kerkhoff
Gert
G
Wilhelm
Frank H
FH
Moebus
Susanne
S
Konstantinides
Stavros
S
Binder
Lutz
L
Heusch
Gerd
G
Siffert
Winfried
W
Budde
Thomas
T
Dobos
Gustav J
GJ
D000368:Aged; D000787:Angina Pectoris / Q000235:genetics; D001341:Autonomic Nervous System / Q000503:physiopathology*; D017704:Baroreflex; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000235:genetics / Q000503:physiopathology / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D015438:Health Behavior; D006339:Heart Rate; D020962:Heterotrimeric GTP-Binding Proteins / Q000235:genetics; D006801:Humans; D008019:Life Style; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D011788:Quality of Life; D012307:Risk Factors
C454420:G-protein beta3 subunit; D020962:Heterotrimeric GTP-Binding Proteins