Lifestyle changes in free-living patients with peripheral vascular disease(Fontaine stage II) related to plasma and LDL lipid composition: a 15 month follow-up study

Peripheral vascular disease (PVD) is characterized by arteriosclerosis and lower extremity ischemia which cause intermittent claudication. Patients gr ouped in the Fontaine stage II have more than 75% organic stenosis in their large coronary arteries and exhibit a number of alterations in blood coagu lation and plasma lipids. The aim of this study was to evaluate an interven tion program of lifestyle habits including dietary recommendations, moderat e exercise and decreased smoking in a population of patients with PVD for a period of 15 months, with respect to plasma-lipid and lipoprotein composit ion as well as LDL susceptibility to peroxidation. These parameters are wel l known risk indicators of arteriosclerosis and coronary heart disease. A t otal 13 subjects diagnosed with PVD (Fontaine stage II) were selected, whil e a healthy age-matched group (n=20) was used as a reference. This study de sign was an uncontrolled trial of lifestyle interventions. The group of pat ients was examined at 0, 3, 6, 9, 12 and 15 months. Patients smoking one or more packets of cigarettes per day at the beginning of the study (54.2%) d ecreased smoking by as much as 7.7% 15 months later. In addition, physical activity intensified significantly (walking > 1 km: 13.1-77%) and treadmill running increased over the study period while the energy intake decreased by 10%. The percentage of saturated fat in the diet decreased by 10% while the intake of polyunsaturated fat rose, and monounsaturated-fat intake show ed a parallel trend to increase; the average intake of cholesterol also fel l by 10% and plasma triglycerides and HDL-cholesterol showed a trend to dec rease and increase, respectively. No permanent changes in LDL lipid fractio ns for patients were detected during the follow-up period and no difference s between patients and the age-matched reference group were found. The macr ophage uptake of plasma-oxidized LDL was significantly higher in patients t han in the reference group and no differences due to the intervention perio d were detected. In conclusion, the education in lifestyle and nutritional habits of patients with PVD led to reduced energy intake parallel with augm ented physical activity as well to a fall in plasma triglycerides and a ris e in HDL-cholesterol, which are good indicators of a reduced risk of vascul ar and myocardial complications. (C) 1999 Harcourt Publishers Ltd.