Key Articles

Question 1

Lifestyle Heart Trial

Answer 1

• Intense Lifestyle Change for 5 years effect on Coronary Heart Disease (CHD) WITHOUT lipid lowering drugs
• Done on 48 adults with moderate to severe CHD, randomized control, parallel, not double blind except radiologists
• Lifestyle change: low fat (10% of calories), vegetarian diet, aerobic exercise, smoking cessation, stress management, group psychosocial support. NO LIPID LOWERING DRUGS were given.

Control: those who followed doctor’s lifestyle recommendation from American Heart Association Step 2 diet.

Results:
- REDUCTION in stenosis of 7.9% vs INCREASE stenosis of 27.7% for control
- 45 cardiac events in control group vs 25 cardiac events in experiment group (more inprovement at 5 yrs)
- 46% inc stenosis with no meds
- LDL reduction at 20% vs 5% for controlled group
- there is dose response ass with adherence and regression (82% of experimental group showed regression)
- 37% reduction of LDL cholesterol
- 91% reduction of anginal episode

Control group:
- 165% increase in anginal episodes
- 42.7% to 46.1% increase in stenosis
- 2x cardiac events vs experimental group

Question 2

Percutaneous Coronary Angioplasty Compared with Exercise Training in Px with Stable Coronary Artery Disease

Answer 2

• Controlled trial in a 12 month period
• 101 males less than 70 year old with stable CAD
• 20 min. bicycle ergometry per day

Control: Percutaneous coronary angioplasty

Results:
- After 12 months, maximal exercise tolerance was increased
- Increase of 16% maximal oxygen uptake
- Expenses for exercise vs PCI was cheaper
- In both groups, clinical symptoms improved significantly during the study period. Hence fewer re-hospitalization and revascularization (cheaper in the long term)

Question 3

Comparison of Atkins, Ornish, Weight watchers and Zone diets for weight loss

Answer 3

• Randomized control 1 yr trial
• 22 to 72 yrs old overweight/obese i dividuals
• 40 individuals each group

Results:
- LDL to HDL cholesterol ratio dec. by 10%
- dietary adherence better than type of diet
- adherence rate less than 25%
- dec level of C reactive protein, and insulin
- lots discontinued because it was too restrictive diet

Question 4

GEMINAL Study

Answer 4

Single arm, pilote, clinical intervention study

• 3 months
• 30 men with low risk prostrate cancer
• in house stay
• improved weight, abdominal obesity, lipid profile, blood pressure
• given tofu, fortified soy, vit E, selenium, vit C, fish oil
• stress management 60 min a day
• mod aerobic walk 30min x 6 days
• 60 min group support session per week

Only 30% sample had tumor
No controlled group (limitation)
This shows lifestyle does not only affect prostate cancer

Question 5

Reversal of T2DM Normalization of Beta Cell Function

Answer 5

• Interventional, with matched control
• (intervention) 1 individuals with DM <4 yrs
• (control) 9 individuals
• 600 calories/day

Outcome
- Fasting plasma glucose from 166 to 106 mg/dL
- insulin suppression inproved from 43 to 74
- hepatic TGA from 12 to 2.9
- Pancreatic TGA from 8 to 6

Limitation
- sample too small
- px had too small duration of DN (<4 yrs)

• results at 1 week, hepatic and pancreatic reversal in 3-4 weeks

Question 6

DUETFITS Randomized Clinical trial

Answer 6

Compared HEALTHY low fat vs low carb at 500-600 calorie deficit

609 adults of BMI 28-40, not diabetic

No statistically difference in weight loss or genetic pattern

Question 7

DIRECT

Answer 7

Open case clister