Kanemitsu Kimberly, Hassan Baran Dilshad, Mdivnishvili Marika, Abbas Noor
Clinical Sciences, Windsor University School of Medicine, Chicago, USA.
College of Medicine, Hawler Medical University, Erbil, IRQ.
Cureus. 2024 Dec 29;16(12):e76585. doi: 10.7759/cureus.76585. eCollection 2024 Dec.
Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, necessitating comprehensive approaches for its management. This systematic review evaluates the long-term impact of structured lifestyle intervention programs on cardiac event-free survival in patients with established CAD. A total of eight studies, including randomized controlled trials (RCTs) and prospective cohort studies, were analyzed, encompassing diverse interventions such as cardiac rehabilitation, dietary modifications, exercise programs, and psychosocial support. The findings indicate that lifestyle interventions significantly improve event-free survival, reduce recurrent cardiac events, and enhance overall health markers as compared to usual care. Intensive interventions, such as comprehensive cardiac rehabilitation, showed the most pronounced benefits, including regression of coronary artery stenosis measured through angiographic imaging and a reduced need for revascularization (relative risk reduction up to 45%; p < 0.05). Flexible and accessible approaches, like home-based or telephonic rehabilitation, demonstrated potential in improving adherence, measured by program completion rates and self-reported lifestyle changes, and outcomes in specific populations such as elderly or high-risk patients. Limitations include variability in intervention intensity, small sample sizes in some studies, and differences in adherence definitions and measurement methods. This review highlights the critical role of lifestyle modifications as a cornerstone of secondary prevention strategies in CAD management and suggests that technology-based and demographic-specific interventions may hold promise for improving long-term outcomes. Future research should focus on long-term sustainability and optimizing tailored intervention designs.
冠状动脉疾病(CAD)是全球发病和死亡的主要原因,因此需要采用综合方法进行管理。本系统评价评估了结构化生活方式干预计划对已确诊CAD患者无心脏事件生存的长期影响。共分析了八项研究,包括随机对照试验(RCT)和前瞻性队列研究,涵盖了多种干预措施,如心脏康复、饮食调整、运动计划和心理社会支持。研究结果表明,与常规护理相比,生活方式干预可显著提高无事件生存率,减少心脏事件复发,并改善整体健康指标。强化干预措施,如综合心脏康复,显示出最显著的益处,包括通过血管造影成像测量的冠状动脉狭窄消退以及血管重建需求减少(相对风险降低高达45%;p<0.05)。灵活且易于实施的方法,如家庭或电话康复,在提高依从性方面显示出潜力,依从性通过计划完成率和自我报告的生活方式改变来衡量,并且在特定人群如老年或高危患者中也取得了良好效果。局限性包括干预强度的变异性、一些研究中的样本量较小以及依从性定义和测量方法的差异。本综述强调了生活方式改变作为CAD管理中二级预防策略基石的关键作用,并表明基于技术和针对特定人群的干预措施可能有望改善长期预后。未来的研究应关注长期可持续性并优化个性化干预设计。