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

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Lipid Metabolism, Nonstatins, Interventions and Imaging, Angiography, Nuclear Imaging, Diet, Exercise, Chronic Angina

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

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