Progression of atherosclerosis in middle-aged men: Effects of multifactorial intervention

Objective. To determine the effect of multifactorial intervention against cardiovascular risk factors on ultrasound-determined progression of atherosclerosis in healthy middle-aged men. Design. One hundred and forty-nine healthy middle-aged men were assigned to an intervention group (IG) or a control group (CG). Subjects. The participants had moderately increased risk-factor scores for cardiovascular disease. They were recruited from a health screening programme at the Preventive Medicine Section, Department of Medicine, Lund University, University Hospital, Malmo. During the study period, 32 of the subjects were lost to follow-up, leaving 59 in the IG and 58 in the CG. Intervention. The IG subjects underwent multifactorial intervention for 2 years, the goal being to help them stop smoking and to reduce their blood lipids and blood pressure. Main outcome measures. Intima-media thickness and plaque score in the right carotid artery were ultrasonographically determined initially and after 2 years. Blood lipids and blood pressure were measured at the same time, and in the IG also after 3, 6, 12 and 18 months after entry into the study. Results. At the entry into the study, there were no significant differences in major risk factors or ultrasound variables between IG and CC. Blood lipids and smoking decreased significantly during the 2 years of intervention in the IG, whilst these factors remained unchanged in the CG, Intima-media thickness and plaque scores increased significantly in both groups. Conclusions. No effects on ultrasound variables could be detected after 2 years of multifactorial intervention. A more aggressive intervention programme, possibly more dependent on pharmacological treatment, may be required to obtain reduced progression or regression of atherosclerosis.