Pischke Claudia R, Weidner Gerdi, Elliott-Eller Melanie, Scherwitz Larry, Merritt-Worden Terri A, Marlin Ruth, Lipsenthal Lee, Finkel Robert, Saunders Donald, McCormac Patty, Scheer Judith M, Collins Richard E, Guarneri Erminia M, Ornish Dean
Preventive Medicine Research Institute, Sausalito.
Am J Cardiol. 2006 May 1;97(9):1267-73. doi: 10.1016/j.amjcard.2005.11.051. Epub 2006 Mar 10.
It is unclear whether patients with coronary artery disease (CAD) and diabetes mellitus (DM) can make comprehensive lifestyle changes that produce similar changes in coronary risk factors and quality of life compared with patients with CAD and without DM. We examined medical characteristics, lifestyle, and quality of life by diabetic status and gender in the Multicenter Lifestyle Demonstration Project (MLDP), a study of 440 nonsmoking patients with CAD (347 men, 55 with DM; 15.9%; 93 women, 36 with DM; 38.7%). Patients met in groups to improve lifestyle (plant-based, low-fat diet; exercise; stress management) for 1 year. Follow-ups were conducted at 3 and 12 months. At baseline, body mass and systolic blood pressure were significantly higher among patients with DM. Men with DM had a worse medical history (e.g., hypertension, hyperlipidemia, and family history of CAD) than did those without DM. Patients with DM, especially women, reported poorer quality of life than did patients without DM. The 2 groups of patients were able to adhere to the recommended lifestyle, as demonstrated by significant improvements in weight (mean -5 kg), body fat, low-density lipoprotein cholesterol, exercise capacity, and quality of life. No significant changes in triglycerides and high-density lipoprotein cholesterol were noted. By the end of 12 months, improvements in glucose-lowering medications (i.e., discontinuation or a change from insulin to oral hypoglycemic agents) were noted for 19.8% (n = 18) of patients with DM. In conclusion, patients with CAD and DM are able to follow a comprehensive lifestyle change program and show similar improvements in coronary risk factors and quality of life as those without DM.
目前尚不清楚，与患有冠状动脉疾病（CAD）但无糖尿病（DM）的患者相比，患有CAD和DM的患者是否能够进行全面的生活方式改变，从而使冠状动脉危险因素和生活质量产生类似的变化。我们在多中心生活方式示范项目（MLDP）中，根据糖尿病状态和性别，对医学特征、生活方式和生活质量进行了研究。该项目纳入了440名不吸烟的CAD患者（347名男性，55名患有DM，占15.9%；93名女性，36名患有DM，占38.7%）。患者分组参加为期1年的改善生活方式项目（以植物为基础的低脂饮食、运动、压力管理）。在3个月和12个月时进行随访。基线时，DM患者的体重和收缩压显著更高。患有DM的男性比未患DM的男性有更差的病史（如高血压、高脂血症和CAD家族史）。患有DM的患者，尤其是女性，报告的生活质量比未患DM的患者差。两组患者都能够坚持推荐的生活方式，体重（平均减轻5 kg）、体脂、低密度脂蛋白胆固醇、运动能力和生活质量都有显著改善，证明了这一点。甘油三酯和高密度脂蛋白胆固醇没有显著变化。到12个月末，19.8%（n = 18）的DM患者降糖药物有改善（即停药或从胰岛素改为口服降糖药）。总之，患有CAD和DM的患者能够遵循全面的生活方式改变计划，并在冠状动脉危险因素和生活质量方面显示出与未患DM的患者类似的改善。
