Lifestyle modifications are the crux of atherosclerotic disease management. The goal
of this study was to determine the effectiveness of diet and exercise in decreasing
coronary and carotid atherosclerotic burden. Randomized controlled trials examining
the effects of intensive lifestyle measures on atherosclerotic progression in coronary
and carotid arteries as measured by baseline and follow-up quantitative coronary angiogram
and ultrasonographic carotid intimal-medial thickness (CIMT), respectively, were included.
Studies were excluded if the intervention additionally included a medication. MEDLINE,
EMBASE, CINAHL, Cochrane Controlled Trials Registers, reports, and abstracts from
major cardiology meetings were searched by 2 researchers independently and verified
by the primary investigator. Standardized mean difference (SMD) with 95% confidence
intervals (CIs) was calculated using random-effects model. Publication bias and heterogeneity
were assessed. Fourteen trials were included. Seven used quantitative coronary angiogram,
and 7 used CIMT; 1,343 lesions in 340 patients in the coronary group and 919 patients
in the carotid group were analyzed. Overall, lifestyle modifications were associated
with a decrease in coronary atherosclerotic burden in percent stenosis by −0.34 (95%
CI −0.48 to −0.21) SMD, with no significant publication bias and heterogeneity (p
= 0.21, I2 = 28.25). Similarly, in the carotids, there was a decrease in the CIMT, in millimeter,
by −0.21 (95% CI −0.36 to −0.05) SMD and by −0.13 (95% CI −0.25 to −0.02) SMD, before
and after accounting for publication bias and heterogeneity (p = 0.13, I2 = 39.91; p = 0.54, I2 = 0), respectively. In conclusion, these results suggest that intensive lifestyle
modifications are associated with a decrease in coronary and carotid atherosclerotic
burden.
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Article info
Publication history
Published online: October 31, 2014
Accepted:
October 17,
2014
Received in revised form:
October 17,
2014
Received:
September 1,
2014
Footnotes
See page 274 for disclosure information.
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
