Heidelberg Trial - Heidelberg


Exercise and diet for atherosclerotic progression in stable angina.


Atherosclerotic lesions may regress spontaneously or in response to normalization of atherogenic factors.

Study Design

Study Design:

Patients Screened: 38
Patients Enrolled: 36
Mean Follow Up: 1 year
Mean Patient Age: 51 ±6 years
Female: 0

Patient Populations:

Male gender
Stable symptoms
Willingness to participate in the study for >12 months
Coronary artery stenoses well documented by angiography


Unstable angina pectoris
Left main coronary artery stenosis >25% reduction in lumen diameter
Severely depressed left ventricular ejection fraction (<35%)
Significant valvular disease
Insulin-dependent diabetes mellitus
Primary hypercholesterolemia (type II hyperlipoproteinemia, low-density lipoprotein >210 mg/dL)
Conditions precluding regular physical exercise

Primary Endpoints:

Changes in coronary morphology, stress-induced ischemia, total cholesterol

Drug/Procedures Used:

Low-fat, low-cholesterol diet (<20 energy % fat, cholesterol <200 mg/dL/day); exercise >3 hours/week.

Principal Findings:

Results were compared with those in patients receiving "usual care." In the intervention group, significant regression of coronary atherosclerotic lesions was noted in 7 of the 18 patients; no change or progression was present in 11 patients.

In patients receiving usual care, regression was detected in only 1, with no change or progression in 11 patients (different from intervention, p <0.05).

There was a significant reduction in stress-induced myocardial ischemia, which was not limited to patients with regression of coronary atherosclerotic lesions.


Regular physical exercise and a low fat diet may retard progression of coronary artery disease. However, improvement of myocardial perfusion may be achieved independently from regression of stenotic lesions.


1. J Am Coll Cardiol 1992;19:34-42. Final results

Keywords: Cholesterol, Atherosclerosis, Coronary Stenosis, Angina, Stable, Coronary Angiography, Exercise, Diet, Fat-Restricted

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