Effects of lifestyle modification on coronary artery calcium progression and prognostic factors in coronary patients--3-year results of the randomized SAFE-LIFE trial.

OBJECTIVE

Given the multimodal medical and interventional treatment options in coronary artery disease (CAD), the current value of intensified lifestyle modification remains unclear. No randomized studies have so far assessed the impact of lifestyle modification on coronary artery calcium (CAC). We examined the long-term effects of a one-year comprehensive lifestyle modification on risk factors and CAC by means of a randomized clinical trial.

METHODS

96 participants (age range 35-75 years, 22 women) of the SAFE-LIFE randomized trial in patients with established CAD completed 3-year follow-up. The active treatment was a one-year lifestyle modification and stress reduction intervention (LG), while the control group received written advice only (AG). CAC (derived from electron beam tomography), blood lipids, heart rate, blood pressure, anginal symptoms and quality-of-life were assessed on entry and at 3-year follow-up.

RESULTS

Lifestyle modification had no impact on change of CAC after three years (median progression factor [25th,75th percentile] 1.46 [1.16,2.19] in LG and 1.41 [1.20,1.79] in AG; p=0.68), but led to reductions of blood pressure, heart rate and to dose-reductions in anti-ischemic medications as compared to AG. Multiple regression analysis indicated that in the pooled study population increase of CAC was related to psychosocial factors and heart rate.

CONCLUSION

In the presence of modern treatments, complementary prescription of comprehensive lifestyle modification has no impact on CAC progression but sustainable benefit for blood pressure, heart rate and the need of anti-ischemic medication is demonstrated. A possible influence of stress reduction measures on CAC progression should be further evaluated.