Author/Authors :
Maron، نويسنده , , David J. and Boden، نويسنده , , William E. and OʹRourke، نويسنده , , Robert A. and Hartigan، نويسنده , , Pamela M. and Calfas، نويسنده , , Karen J. and Mancini، نويسنده , , G.B. John and Spertus، نويسنده , , John A. and Dada، نويسنده , , Marcin and Kostuk، نويسنده , , William J. and Knudtson، نويسنده , , Merril and Harris، نويسنده , , Crystal L. and Sedlis، نويسنده , , Steven P. and Zoble، نويسنده , , Robert G. and Title، نويسنده , , Lawrence M. and Gosselin، نويسنده , , Gilbert and Nawaz، نويسنده , , Shah and Gau، نويسنده , , Gerald T. and Blaustein، نويسنده , , Alvin S. and Bates، نويسنده , , Eric R. and Shaw، نويسنده , , Leslee J. and Berman، نويسنده , , Daniel S. and Chaitman، نويسنده , , Bernard R. and Weintraub، نويسنده , , William S. and Teo، نويسنده , , Koon K.، نويسنده ,
Abstract :
Objectives
aper describes the medical therapy used in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial and its effect on risk factors.
ound
ardiovascular clinical trials test a single intervention. The COURAGE trial tested multiple lifestyle and pharmacologic interventions (optimal medical therapy) with or without percutaneous coronary intervention in patients with stable coronary disease.
s
tients, regardless of treatment assignment, received equivalent lifestyle and pharmacologic interventions for secondary prevention. Most medications were provided at no cost. Therapy was administered by nurse case managers according to protocols designed to achieve predefined lifestyle and risk factor goals.
s
tients (n = 2,287) were followed for 4.6 years. There were no significant differences between treatment groups in proportion of patients achieving therapeutic goals. The proportion of smokers decreased from 23% to 19% (p = 0.025), those who reported <7% of calories from saturated fat increased from 46% to 80% (p < 0.001), and those who walked ≥150 min/week increased from 58% to 66% (p < 0.001). Body mass index increased from 28.8 ± 0.13 kg/m2 to 29.3 ± 0.23 kg/m2 (p < 0.001). Appropriate medication use increased from pre-randomization to 5 years as follows: antiplatelets 87% to 96%; beta-blockers 69% to 85%; renin-angiotensin-aldosterone system inhibitors 46% to 72%; and statins 64% to 93%. Systolic blood pressure decreased from a median of 131 ± 0.49 mm Hg to 123 ± 0.88 mm Hg. Low-density lipoprotein cholesterol decreased from a median of 101 ± 0.83 mg/dl to 72 ± 0.88 mg/dl.
sions
ary prevention was applied equally and intensively to both treatment groups in the COURAGE trial by nurse case managers with treatment protocols and resulted in significant improvement in risk factors. Optimal medical therapy in the COURAGE trial provides an effective model for secondary prevention among patients with chronic coronary disease. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657)
