Delayed progression or regression of coronary atherosclerosis with intensive risk factor modification. Effects of diet, drugs, and exercise.

Until the mid 1980s, secondary prevention of coronary atherosclerosis focused primarily on early ambulation, exercise training, and a 'prudent' diet. These regimens generally resulted in improved functional capacity, reduced myocardial demands at submaximal workrates, and modest decreases in cardiovascular mortality. However, reinfarction rates and the course of atherosclerotic heart disease remained largely unchanged with traditional treatment or usual care. Contemporary studies now suggest that multifactorial risk factor modification, and especially more intensive measures to control hyperlipidaemia with diet, drugs, and exercise, may slow, halt, and even reverse the progression of atherosclerotic coronary artery disease. Added benefits include a reduction in anginal symptoms, decreases in exercise-induced myocardial ischaemia, fewer recurrent cardiac events, and a diminished need for coronary revascularisation procedures. Several mechanisms may contribute to these improved clinical outcomes, including partial (albeit small) anatomic regression of coronary artery stenoses, a reduced incidence of plaque rupture, and improved coronary artery vasomotor function. These findings suggest a new paradigm in the treatment of patients with coronary artery disease.