Esselstyn C B, Ellis S G, Medendorp S V, Crowe T D
Department of General Surgery, Cleveland Clinic Foundation, OH 44195, USA.
J Fam Pract. 1995 Dec;41(6):560-8.
Animal experiments and epidemiological studies have suggested that coronary disease could be prevented, arrested, or even reversed by maintaining total serum cholesterol levels below 150 mg/dL (3.88 mmol/L). In 1985, we began to study how effective one physician could be in helping patients achieve this cholesterol level and what the associated effect of achieving and maintaining this cholesterol level has on coronary disease.
The study included 22 patients with angiographically documented, severe coronary artery disease that was not immediately life threatening. These patients took cholesterol-lowering drugs and followed a diet that derived no more than 10% of its calories from fat. Disease progression was measured by coronary angiography and quantified with the percent diameter stenosis and minimal lumen diameter methods. Serum cholesterol was measured biweekly for 5 years and monthly thereafter.
Of the 22 participants, 5 dropped out within 2 years, and 17 maintained the diet, 11 of whom completed a mean of 5.5 years of follow-up. All 11 of these participants reduced their cholesterol level from a mean baseline of 246 mg/dL (6.36 mmol/L) to below 150 mg/dL (3.88 mmol/L). Lesion analysis by percent stenosis showed that of 25 lesions, 11 regressed and 14 remained stable. Mean arterial stenosis decreased from 53.4% to 46.2% (estimated decrease = 7%; 95% confidence interval [CI], 3.3 to 10.7, P < .05). Analysis by minimal lumen diameter of 25 lesions found that 6 regressed, 14 remained stable, and 5 progressed. Mean lumen diameter increased from 1.3 mm to 1.4 mm (estimated increase = 0.08 mm; 95% CI, -0.06 to 0.22, P = NS). Disease was clinically arrested in all 11 participants, and none had new infarctions. Among the 11 remaining patients after 10 years, six continued the diet and had no further coronary events, whereas the five dropouts who resumed their prestudy diet reported 10 coronary events.
A physician can influence patients in the decision to adopt a very low-fat diet that, combined with lipid-lowering drugs, can reduce cholesterol levels to below 150 mg/dL and uniformly result in the arrest or reversal of coronary artery disease.
动物实验和流行病学研究表明，通过将血清总胆固醇水平维持在150mg/dL（3.88mmol/L）以下，可以预防、控制甚至逆转冠心病。1985年，我们开始研究一名医生在帮助患者达到这一胆固醇水平方面的效果如何，以及达到并维持这一胆固醇水平对冠心病的相关影响。
该研究纳入了22例经血管造影证实患有严重冠状动脉疾病但并非立即危及生命的患者。这些患者服用降胆固醇药物，并遵循一种脂肪供能不超过10%的饮食。通过冠状动脉造影测量疾病进展，并用直径狭窄百分比和最小管腔直径方法进行量化。在5年中每两周测量一次血清胆固醇，此后每月测量一次。
在22名参与者中，5人在2年内退出，17人维持饮食，其中11人完成了平均5.5年的随访。所有这11名参与者的胆固醇水平均从平均基线水平246mg/dL（6.36mmol/L）降至150mg/dL（3.88mmol/L）以下。按狭窄百分比进行的病变分析显示，在25处病变中，11处病变缩小，14处病变保持稳定。平均动脉狭窄从53.4%降至46.2%（估计下降7%；95%置信区间[CI]，3.3至10.7，P<.05）。按25处病变的最小管腔直径分析发现，6处病变缩小，14处病变保持稳定，5处病变进展。平均管腔直径从1.3mm增加到1.4mm（估计增加0.08mm；95%CI，-0.06至0.22，P=无统计学意义）。所有11名参与者的疾病在临床上均得到控制，且无人发生新的梗死。10年后，在剩下的11名患者中，6人继续饮食且未发生进一步的冠状动脉事件，而5名恢复研究前饮食的退出者报告了10次冠状动脉事件。
医生可以影响患者决定采用极低脂肪饮食，这种饮食与降脂药物相结合，可以将胆固醇水平降低至150mg/dL以下，并一致导致冠状动脉疾病的控制或逆转。
