Cardiovascular Diseases Clinical Trial
To determine whether modification of risk factors altered the rate of progression of coronary artery disease in arteries with mild atherosclerosis and no mechanical intervention in patients who had coronary bypass surgery or percutaneous transluminal coronary angioplasty (PTCA).
BACKGROUND:
Because of difficulties with quantitative measurement and with feasibility of follow-up, few
controlled studies prior to SCRIP had been completed to determine the impact of risk factor
modification directly on the progression of coronary atherosclerosis in humans. Suggestive
evidence existed from animal studies, especially in primates, that diet and exercise altered
atherosclerosis as a result of risk modification. But these animal models did not accurately
represent the potential for modifying the coronary atherosclerotic process in humans. Some
indirect evidence had been developed in humans by studying arteries more accessible than the
coronaries. In the several preliminary studies reported using coronary arteriography to
study the impact of risk modification on atherosclerosis, the results had been encouraging
but far from definitive. One angiographic follow-up study of vein bypass grafts and severely
atherosclerotic coronary arteries reported improvement with lipid lowering therapy. None of
these studies had included randomization of patients to systematic, intense, long-term risk
reduction versus usual care with prospectively identified coronary artery segments with mild
disease.
DESIGN NARRATIVE:
Randomized, fixed-sample. A total of 300 patients were randomized, 155 to usual care (UC) in
the community and 145 to special intervention (SI). The SI group received intensive efforts
directed at reducing or eliminating risk factors, including lowering LDL-cholesterol and
increasing HDL-cholesterol, reducing blood pressure, eliminating cigarette smoking and
obesity, increasing exercise, and decreasing stressful life experience. The major endpoint
was the rate of coronary artery disease progression as measured by angiography, at baseline
and at forty-eight months. Follow-up was for four years.
;
Allocation: Randomized, Primary Purpose: Prevention
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