Elsevier

The Lancet

Volume 339, Issue 8793, 7 March 1992, Pages 563-569
The Lancet

ORIGINAL ARTICLES
Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS)

https://doi.org/10.1016/0140-6736(92)90863-XGet rights and content

Abstract

To assess the effect of dietary reduction of plasma cholesterol concentrations on coronary atherosclerosis, we set up a randomised, controlled, end-point-blinded trial based on quantitative image analysis of coronary angiograms in patients with angina or past myocardial infarction. Another intervention group received diet and cholestyramine, to determine the effect of a greater reduction in circulating cholesterol concentrations. 90 men with coronary heart disease (CHD), who had a mean (SD) plasma cholesterol of 7·23 (0·77) mmol/l were randomised to receive usual care (U, controls), dietary intervention (D), or diet plus cholestyramine (DC), with angiography at baseline and at 39 (SD 3·5) months. Mean plasma cholesterol during the trial period was 6·93 (U), 6·17 (D), and 5·56 (DC) mmol/l. The proportion of patients who showed overall progression of coronary narrowing was significantly reduced by both interventions (U 46%, D 15%, DC 12%), whereas the proportion who showed an increase in luminal diameter rose significantly (U 4%, D 38%, DC 33%). The mean absolute width of the coronary segments (MAWS) studied decreased by 0·201 mm in controls, increased by 0·003 mm in group D, and increased by 0·103 mm in group DC (p<0·05), with improvement also seen in the minimum width of segments, percentage diameter stenosis, and edge-irregularity index in intervention groups. The change in MAWS was independently and significantly correlated with LDL cholesterol concentration and LDL/HDL cholesterol ratio during the trial period. Both interventions significantly reduced the frequency of total cardiovascular events. Dietary change alone retarded overall progression and increased overall regression of coronary artery disease, and diet plus cholestyramine was additionally associated with a net increase in coronary lumen diameter. These findings support the use of a lipid-lowering diet, and if necessary of appropriate drug treatment, in men with CHD who have even mildly raised serum cholesterol concentrations.

References (35)

  • B. Lewis et al.

    Serum lipoprotein abnormalities in patients with ischaemic heart disease: comparisons with a control population

    Br Med J

    (1974)
  • L. Campeau

    Grading of angina pectoris

    Circulation

    (1976)
  • Wg Austen et al.

    AHA committee report. A reporting system on patients evaluated for coronary artery disease

    Circulation

    (1975)
  • Acf Colchester et al.

    Measurement of vessel calibre and volume blood flow by dynamic quantitative digital angiography: an initial application showing variation of cerebral artery diameter with PaCO2

    J Cerebr Blood Flow Metab

    (1983)
  • Sm Astley et al.

    Exploitation of computer vision technology in coronary cineangiographic analysis. (Computers in cardiology, 13.)

    (1987)
  • Jnh Brunt, Design, implementation, validation and use of a system for quantitative coronary cineangiography...
  • Bg Brown et al.

    Arteriographic assessment of coronary atherosclerosis

    Arteriosclerosis

    (1982)
  • Cited by (755)

    • Effect of dietary fatty acid intake on cardiovascular disease

      2023, Functional Dietary Lipids: Food Formulation, Consumer Issues, and Innovation for Health, Second Edition
    • Bile acid coordinates microbiota homeostasis and systemic immunometabolism in cardiometabolic diseases

      2022, Acta Pharmaceutica Sinica B
      Citation Excerpt :

      BA sequestrants, including colesevelam, colestimide, cholestyramine, and colestipol, have beneficial effects on lipid metabolism, glycemic control and insulin sensitivity in AS and diabetic rodents125,126. Cholestyramine is well tolerated and to exert cholesterol-lowering effects as well as to reduce CVD mortality127,128. A randomized clinical trial demonstrated that together with a fat-modified diet, cholestyramine could improve the course of CVD in men with phenotypic familial hypercholesterolaemia129.

    View all citing articles on Scopus
    View full text