Long-term Effects of Lifestyle Modification on Cardiovascular Function and Subsequent Drug Treatment in High-risk Individuals

Abstract

PURPOSE: To assess 1) the long-term effects of lifestyle modification, and 2) the effects of an angiotensin receptor blocker (telmisartan) on central artery stiffness and endothelial function in people at increased risk for cardiovascular disease (CVD). METHODS: This is a follow-up study of the SNAC (Staged Nutrition and Activity Counseling) study that originally examined the effects of lifestyle modification prescribed by family physicians on cardiovascular structures and function in people at increased risk for CVD. Twenty-four subjects (58.5±8.4 yrs, 12F) were assessed following (mean of 26.3 months) discontinuation of the 1-year SNAC study. Carotid artery stiffness and flow-mediated dilation (FMD) of the brachial artery were assessed by Doppler ultrasound. Components of the metabolic syndrome (MS) [triglycerides (TG), high-density lipoprotein cholesterol, blood pressure (BP), fasting glucose (FG), and waist circumference] and exercise capacity (VO2max by treadmill test) were also assessed. Subsequently, 17 subjects (58.0±7.9 yrs, 7F) were reassessed following the 24-week telmisartan treatment. RESULTS: The reduction in carotid artery stiffness observed at 1-year was still maintained at the time of follow-up, whereas the improved FMD at 1-year returned to the pre-intervention level (p<0.05). Similarly, the reductions in TG and FG seen at 1-year were maintained at the time of follow-up (p<0.05). Following the 24-week telmisartan treatment, carotid artery stiffness and FMD significantly improved even after adjusting for confounders. While BP was significantly reduced (DSBP 13.6±16.3 mmHg, DDBP 7.9±5.6 mmHg, p<0.05), other MS components and VO2max remained unchanged throughout the drug treatment. CONCLUSIONS: These results show that 1) our lifestyle modification strategy can maintain a reduction in carotid artery stiffness as well as TG and FG even after the active intervention, and 2) the telmisartan treatment may be another option to reduce carotid artery stiffness and improve endothelial function in this population. Future study will answer whether the reduction in central artery stiffness would lead to a reduction in the occurrence of CVD. Supported by a grant from Lawson Health Research Institute.