Schaefer S, Hussein H, Gershony G R, Rutledge J C, Kappagoda C T
Division of Cardiovascular Medicine, University of California, Davis 95616, USA.
J Investig Med. 1997 Dec;45(9):536-41.
Intensive risk factor reduction in patients with dyslipidemias and coronary atherosclerosis has been shown to result in alterations in coronary artery morphology and reduced clinical events. However, the impact of such interventions in populations with relatively normal levels of low-density lipoproteins (LDL) is unclear.
To test the hypothesis that intensive risk factor reduction results in angiographic regression in patients with only mildly elevated levels of LDL, 14 patients with angiographically proven coronary atherosclerosis were entered into the University of California Davis Coronary Artery Disease Regression Program and intensively treated with pharmacologic and nonpharmacologic interventions for 2 years. Quantitative angiography was performed prior to and after 2 years of therapy to determine changes in coronary artery diameter.
As a result of this program, dietary fat intake was reduced by 58% and LDL fell from 120 +/- 7 mg/dL to 104 +/- 6 mg/dL (p = 0.05). The average diameter of the measured arterial locations (including all 53 stenoses and 292 nondiscrete regions) on study entry was 2.74 +/- 0.05 mm. After 24 months, there was a net increase in arterial diameter (regression) of +0.05 +/- 0.04 mm to 2.81 +/- 0.05 mm (p = 0.01). While there was no significant change in the average diameter of discrete stenoses, all 8 lesions > or = 50% initial diameter narrowing regressed, with a mean diameter change of + 0.2 mm. Conversely, only 1 of 8 mild lesions < or = 20% regressed, while 4 progressed. Intermediate lesions (20% to 50%, n = 37) had balanced progression and regression.
When examined as a continuous variable, there was a significant linear correlation between initial lesion severity (% stenosis) and the extent of regression (mm). Therefore, risk factor reduction (dietary therapy, exercise, psycho-social counseling, and lipid lowering therapy) in patients with only mild dyslipidemia results in angiographic regression of more severe lesions (> 50% initial stenosis), but does not prevent progression of mild lesions (< 20%). These findings demonstrate that intensive risk factor reduction in patients with only mild elevation of lipids beneficially influences the morphology of the most severe lesions.
降低血脂异常和冠状动脉粥样硬化患者的强化危险因素已被证明可导致冠状动脉形态改变并减少临床事件。然而，此类干预措施对低密度脂蛋白（LDL）水平相对正常人群的影响尚不清楚。
为了验证强化降低危险因素可使LDL水平仅轻度升高的患者出现血管造影显示的病变消退这一假设，14例经血管造影证实患有冠状动脉粥样硬化的患者进入加利福尼亚大学戴维斯分校冠状动脉疾病消退项目，并接受药物和非药物干预强化治疗2年。在治疗前和治疗2年后进行定量血管造影，以确定冠状动脉直径的变化。
通过该项目，饮食脂肪摄入量减少了58%，LDL从120±7mg/dL降至104±6mg/dL（p = 0.05）。研究入组时所测量动脉部位（包括所有53处狭窄和292个非离散区域）的平均直径为2.74±0.05mm。24个月后，动脉直径净增加（消退）0.05±0.04mm，达到2.81±0.05mm（p = 0.01）。虽然离散狭窄的平均直径没有显著变化，但所有8处初始直径狭窄≥50%的病变均出现消退，平均直径变化为+0.2mm。相反，8处轻度病变（≤20%）中只有1处出现消退，而4处出现进展。中度病变（20%至50%，n = 37）的进展和消退情况相当。
当作为连续变量进行检查时，初始病变严重程度（狭窄百分比）与消退程度（mm）之间存在显著的线性相关性。因此，仅轻度血脂异常患者降低危险因素（饮食治疗、运动、心理社会咨询和降脂治疗）可使更严重病变（初始狭窄>50%）出现血管造影显示的消退，但不能阻止轻度病变（<20%）的进展。这些发现表明，仅轻度血脂升高患者强化降低危险因素对最严重病变的形态有有益影响。
