A STRATEGY TO ARREST AND REVERSE CORONARY-ARTERY DISEASE - A 5-YEAR LONGITUDINAL-STUDY OF A SINGLE PHYSICIANS PRACTICE

Background. Animal experiments and epidemiological studies have sugges ted that coronary disease could be prevented, arrested, or even revers ed by maintaining total serum cholesterol levels below 150 mg/dL (3,88 mmol/ L). In 1985, we began to study how effective one physician coul d be in helping patients achieve this cholesterol level and what the a ssociated effect of achieving and maintaining this cholesterol lever h as on coronary disease. Methods. The study included 22 patients with a ngiographically documented, severe corollary artery disease that was n ot immediately life threatening. These patients took cholesterol-lower ing drugs and followed a diet that derived no more than 10% of its cal ories from fat. Disease progression was measured by coronary angiograp hy and quantified with the percent diameter stenosis and minimal lumen diameter methods. Serum cholesterol was measured byweekly for 5 years and monthly thereafter. Results. Of the 22 participants, 5 dropped ou t within 2 years, and 17 maintained the diet, 11 of whom completed a m ean of 5.5 years of follow-up, All 11 of these participants reduced th eir 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 a rterial stenosis decreased from 53.4% to 96.2% (estimated decrease=7%; 95% confidence interval [Cl], 3.3 to 10.7, P<.05). Analysis by minima l lumen diameter of 25 lesions found that 6 regressed, 14 remained sta ble, 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 clinially arrested in all 11 participants, and none had new infar ctions. Among the II 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. Conclusi ons. A physician can influence patients in the decision to adopt 3 ver y low-fat diet that, combined with lipid-lowering drugs, can reduce ch olesterol levels to below 150 mg/dL and uniformly result in the arrest or reversal of coronary aetery disease.