Topline:
In patients with a chronic stable coronary coronary disease (CAD), the integration of intensive changes in lifestyle and a objective -directed medical therapy – while reserving revascularization for those who have a seriously reduced coronary flow capacity – have caused an improvement in risk factor and better clinical results.
METHODOLOGY:
- Texas researchers have conducted a monocentric randomized trial to assess the effectiveness of the combination of lifestyle modifications with aggressive medical treatment in patients with subclinical, suspected or established framework and the factors that put them at a high risk of poor results.
- Between 2009 and 2017, patients aged 40 or over were randomly assigned to receive comprehensive care (n = 513; average age, 61 years; 67% of men) or standard care (n = 515; average age, 61 years; 69% of men). After randomization, all patients have undergone a basic stress of stress to quantify the capacity of coronary flow and accordingly to report or guide interventions.
- Complete care involved intensive lifestyle advice, a regular examination of the results of PETs and targeted steps to the objectives of the predefined risk factor. Patients also received frequent follow-ups and 24 hours a day on the phone or assistance by email. Those who do not have a seriously reduced coronary flow capacity have been managed without invasive interventions.
- Standard care involved no examination of the results or contacts for support, and the results of the PETs were not blind only to patients with a coronary flow capacity seriously reduced to a high risk of mortality to consider potential revascularization.
- The main result was a change in the risk score summoned by 16 individual risk factors over a 5 -year follow -up period. The main unwanted heart events, their components and revascularization after 90 days were assessed as secondary results.
TAKE AWAY:
- At 5 years old, patients receiving full care had a lower -ordered risk score than those who receive standard care (difference in change of 5 years, -1.4; P <.0001), as well as significant improvements in individual risk factors such as low density lipoproteins, BMI and blood pressure (P <0.01 for all).
- During 11 years of prolonged follow -up, the full care group had 31.4% fewer major unwanted heart events, 42.7% less death, 37% less death or myocardial infarction events and 35.1% less revascularization than the standard care group (P <0.05 for all).
- Only 5.4% of patients underwent revascularization in 90 days, which was mainly guided by the severity of the capacity of the coronary flow.
IN PRACTICE:
“The randomized, controlled and blind trial over 5 years, shows that participants for which invasive coronary procedures have been deferred in complete safety on the basis of (coronary flow capacity) by PET, integrated into complete and intense changes in lifestyle and a significant reduction in the medical comedory,” said the researchers.
“The examination of risk factors, PET images and frequent contacts of participants with participants with the research staff (trial) seem to improve the membership of the standard care group compared to the standard care group,” they added.
SOURCE:
This study was conducted by K. Lance Gould, MD, from the Faculty of Medicine at the University of Texas McGovern in Houston. It was published online May 29, 2025, European Heart Journal.
BOUNDARIES:
This study was conducted in a single center. About 23% of patients did not participate in follow -up visits or TEP analyzes. Images of blinding coronary calcium and myocardial infusion in patients receiving standard care could have been a bias source.
Disclosure:
This study received the support of the Weatherhead Pet Center Endowment at the University of Texas-Houseston. An author said they received internal funding from the funding source and being a PET K231731 software seeker in FDA. An author said he was the principal researcher of a test that receives the support of a medical devices. Several authors have said they had made a personal donation of honor or renouncing their rights on fees to avoid conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human publishers examined this content before the publication.