Effects of intensified lifestyle modification on the need for further revascularization after coronary angioplasty

Background In patients with coronary artery disease (CAD), a rate of resten osis as high as 50% is observed after percutaneous transluminal coronary an gioplasty (PTCA). Frequently, this results in further revascularization pro cedures. Lifestyle intervention has been shown to slow the progression of C AD and to reduce cardiovascular events after myocardial infarction. However , no information exists whether such treatment influences the rate of reste nosis in patients with CAD. The present study was performed to investigate the effects of an intensified lifestyle intervention on the need for furthe r revascularization procedures in patients with established CAD after succe ssful PTCA. Design A total of 60 patients were included and randomized to either conven tional treatment by cardiologists and general practitioners or additional i ntensified lifestyle intervention in a diabetes and metabolism outpatient c linic for 12 months. The mean observation time after successful PTCA was 26 months. The primary outcome variable was the need for further revasculariz ation procedures because of clinical restenosis. Secondary outcome variable s were lifestyle-related measures. Results Intervention resulted in a reduction in body weight and blood press ure, and in increased physical activity. Furthermore, nutritional habits we re changed towards less fat intake, and body composition changed towards a higher proportion of fat-free mass. The need for further revascularization procedures was reduced from a total of 14 out of 32 in the conventionally t reated group to 3 out of 28 in the intervention group. This resulted in an event-free survival probability of 0.89 in the intervention group and 0.57 in the control group (P = 0.0055, log rank) with a resulting relative risk of 0.26 (95% CI 0.09-0.74). Conclusion In conclusion, our data strongly suggest that intensified lifest yle modification is able to reduce the need for further revascularization p rocedures after PTCA in patients with CAD.