***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Recent clinical trials have shown that modification of plasma lipoprotein concentrations can favorably alter progression of coronary atherosclerosis , but no data exist on the effects of a comprehensive program of risk reduction involving both changes in lifestyle and medications . This study tested the hypothesis that intensive multiple risk factor reduction over 4 years would significantly reduce the rate of progression of atherosclerosis in the coronary arteries of men and women compared with subjects r and omly assigned to the usual care of their physician .  METHODS AND RESULTS Three hundred men ( n = 259 ) and women ( n = 41 ) ( mean age , 56 + /- 7.4 years ) with angiographically defined coronary atherosclerosis were r and omly assigned to usual care ( n = 155 ) or multifactor risk reduction ( n = 145 ) . Patients assigned to risk reduction were provided individualized programs involving a low-fat and -cholesterol diet , exercise , weight loss , smoking cessation , and medications to favorably alter lipoprotein profiles . Computer-assisted quantitative coronary arteriography was performed at baseline and after 4 years . The main angiographic outcome was the rate of change in the minimal diameter of diseased segments . All subjects underwent medical and risk factor evaluations at baseline and yearly for 4 years , and reasons for all hospitalizations and deaths were documented . Of the 300 subjects r and omized , 274 ( 91.3 % ) completed a follow-up arteriogram , and 246 ( 82 % ) had comparative measurements of segments with visible disease at baseline and follow-up . Intensive risk reduction result ed in highly significant improvements in various risk factors , including low-density lipoprotein cholesterol and apolipoprotein B ( both , 22 % ) , high-density lipoprotein cholesterol ( + 12 % ) , plasma triglycerides ( -20 % ) , body weight ( -4 % ) , exercise capacity ( + 20 % ) , and intake of dietary fat ( -24 % ) and cholesterol ( -40 % ) compared with relatively small changes in the usual-care group . No change was observed in lipoprotein(a ) in either group . The risk-reduction group showed a rate of narrowing of diseased coronary artery segments that was 47 % less than that for subjects in the usual-care group ( change in minimal diameter , -0.024 + /- 0.066 mm/y versus -0.045 + /- 0.073 mm/y ; P < .02 , two-tailed ) . Three deaths occurred in each group . There were 25 hospitalizations in the risk-reduction group initiated by clinical cardiac events compared with 44 in the usual-care group ( rate ratio , 0.61 ; P = .05 ; 95 % confidence interval , 0.4 to 0.9 ) . CONCLUSIONS Intensive multifactor risk reduction conducted over 4 years favorably altered the rate of luminal narrowing in coronary arteries of men and women with coronary artery disease and decreased hospitalizations for clinical cardiac events In this study , 113 patients with modestly elevated levels of low-density lipoprotein cholesterol ( < 210 mg/dl ) and coronary artery disease were r and omized to an  intervention group ( n=56 ) or a control group ( n=57 ) . The intervention program consisted of daily exercise and a low-fat diet according to the American Heart Association 's recommendation phase III ; patients in the control group received " usual care " rendered by their private physician . After 1 year , complete data were available for all 92 patients ( intervention : n=40 ; control : n=52 ) who underwent repeat coronary angiography .  During the study course , patients in the intervention group showed an increase in apolipoprotein A-I(123 + /- 18 vs 129 + /- 20 mg/dl ; p < 0.02 ) and apolipoprotein A-I/B ( 1.3 + /- 0.4 vs 1.5 + /- 0.4 ; p < 0.01 ) and a decrease in apolipoprotein B ( 99 + /- 20 vs 89 + /- 18 mg/dl ; p < 0.01 ) , while apolipoprotein A-II remained unchanged ( 38 + /- 6 vs 38 + /- 6 mg/dl ; p = NS ) . In the control group , there were no significant changes ( apolipoprotein A-I , 124 + /- 17 vs 128 + /- 13 mg/dl ; apolipoprotein A-II , 38 + /- 6 vs 39 + /- 6 mg/dl ; apolipoprotein B , 100 + /- 21 vs 99 + /- 16 mg/dl ; apolipoprotein A-I/B , 1.3 + /- 0.3 vs 1.4 + /- 0.5 ; all p = NS ) . As previously reported , there was a significant retardation of progression in patients in the intervention group ( progression 23 % , no change 45 % , regression 32 % ) compared with the control group ( progression 48 % , no change 35 % , regression 17 % ) ( p < 0.05 ) . Although retardation of progression was significantly associated with an increase in apolipoprotein A-I/B and a decrease in apolipoprotein B ( p < 0.05 ) , these gave way in multivariate analysis to changes in total cholesterol/high-density lipoprotein cholesterol , absolute levels of low-density lipoprotein cholesterol , and , in a subgroup of patients , to leisure-time physical activity ( all p < 0.05 ) . These data demonstrate that an intervention based on a low-fat diet and intensive physical exercise is capable of improving apolipoprotein levels , associated with retardation of progression of coronary artery disease . However ,  total cholesterol/high-density lipoprotein cholesterol and low-density lipoprotein cholesterol  appear superior to apolipoproteins as metabolic markers for effective treatment in patients with coronary artery disease In a prospect i ve , r and omised , controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year , 28 patients were assigned to an experimental group ( low-fat vegetarian diet , stopping smoking , stress management training , and moderate exercise ) and 20 to a usual-care control group . 195 coronary artery lesions were analysed by quantitative coronary angiography  . The average percentage diameter stenosis regressed from 40.0 ( SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)% in the control group . When only lesions greater than 50 % stenosed were analysed , the average percentage diameter stenosis regressed from 61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group . Overall , 82 % of experimental-group patients had an average change towards regression .  Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year , without use of lipid-lowering drugs BACKGROUND The " Mediterranean " diet and statin treatment have both independently been shown to improve survival and reduce the risk of cardiovascular events in patients with ischemic heart disease ( IHD ) , but no studies have evaluated the effect of this combination on endothelial function . We therefore sought to evaluate the effect of the combination dietary intervention and lipid-lowering treatment on brachial vasoreactivity . METHODS A total of 131 consecutive patients with documented IHD and a serum cholesterol level > or = 5 mmol/L ( 193 mg/dL ) were r and omized to receive Mediterranean dietary advice ( n = 68 ) or no specific dietary advice ( n = 63 ) . Endothelial function was assessed at baseline and after 12 months with noninvasive ultrasound scanning vessel-wall tracking of brachial artery flow-mediated vasodilatation ( FMD ) . All patients started statin treatment with Fluvastatin ( 40 mg once daily ) at baseline . RESULTS A total of 115 patients completed the study . At baseline , FMD was 4.30 % + /- 4.89 % in the control group versus 4.32 % + /- 6.15 % in the intervention group ( P = not significant ) . After 12 months of follow-up , FMD was significantly higher in the intervention group ( control group 5.72 % + /- 4.87 % vs intervention group 8.62 % + /- 6.60 % , P < .01 ) . This was accompanied by a larger intake of fatty fish and a significant decrease in triglyceride levels . In multivariate analysis , r and omization status was a significant predictor of FMD after adjustment for classic cardiovascular risk factors and vessel size ( P = .02 ; beta = -2.66 [ -4.91 ; -0.41 ] ) . CONCLUSION Dietary intervention with the Mediterranean diet and statin treatment improve FMD in the brachial artery in patients with IHD and hypercholesterolemia to a greater degree than statin treatment alone Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more To assess the effect of dietary reduction of plasma cholesterol concentrations on coronary atherosclerosis , we set up a r and omised , controlled , end-point-blinded trial based on quantitative image analysis of coronary angiograms in patients with angina or past myocardial infa rct ion . Another intervention group received diet and cholestyramine , to determine the effect of a greater reduction in circulating cholesterol concentrations . 90 men with coronary heart disease ( CHD ) , who had a mean ( SD ) plasma cholesterol of 7.23 ( 0.77 ) mmol/l were r and omised to receive usual care ( U , controls ) , dietary intervention ( D ) , or diet plus cholestyramine ( DC ) , with angiography at baseline and at 39 ( SD 3.5 ) months . Mean plasma cholesterol during the trial period was 6.93 ( U ) , 6.17 ( D ) , and 5.56 ( DC ) mmol/l . The proportion of patients who showed overall progression of coronary narrowing was significantly reduced by both interventions ( U 46 % , D 15 % , DC 12 % ) , whereas the proportion who showed an increase in luminal diameter rose significantly ( U 4 % , D 38 % , DC 33 % ) . The mean absolute width of the coronary segments ( MAWS ) studied decreased by 0.201 mm in controls , increased by 0.003 mm in group D , and increased by 0.103 mm in group DC ( p less than 0.05 ) , with improvement also seen in the minimum width of segments , percentage diameter stenosis , and edge-irregularity index in intervention groups . The change in MAWS was independently and significantly correlated with LDL cholesterol concentration and LDL/HDL cholesterol ratio during the trial period . Both interventions significantly reduced the frequency of total cardiovascular events . Dietary change alone retarded overall progression and increased overall regression of coronary artery disease , and diet plus cholestyramine was additionally associated with a net increase in coronary lumen diameter . These findings support the use of a lipid-lowering diet , and if necessary of appropriate drug treatment , in men with CHD who have even mildly raised serum cholesterol concentrations The study deals with 412 men , aged 30 to 64 years , r and omized 1 to 2 years after a first myocardial infa rct ion . For the experimental group a diet low in saturated fats and cholesterol , and high in polyunsaturated fats was recommended . After 5 years , as reported previously , the incidence of fatal and nonfatal myocardial reinfa rct ion was found to be significantly reduced . “ Sudden death ” was uninfluenced . Major coronary heart disease ( CHD ) relapses , including fatal and nonfatal events ( MI ) , were significantly reduced ( P = 0.05).After 11 years , death from all causes had occurred in 101 of the original dieters and 108 controls . A significantly reduced myocardial infa rct ion mortality in the original diet group was found ( 32 versus 57 , P = 0.004 ) . The total number of coronary deaths ( fatal myocardial infa rct ion and sudden death ) was 79 in the diet group and 94 in the control group ( P = 0.097).The CHD mortality was correlated with age , serum cholesterol level , blood pressure , body weight , smoking habits , and a combination of these risk factors BACKGROUND The rapid emergence of coronary artery disease ( CAD ) in south Asian people is not explained by conventional risk factors . In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid , we assessed the benefits of this diet for patients at high risk of CAD . METHODS We did a r and omised , single-blind trial in 1000 patients with angina pectoris , myocardial 
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The multivariate and univariate model showed no significant associations between the independent variables and the changes from saturated fat , monounsaturated fat , polyunsaturated fat and linoleic acid .
Sensitivity analyses did not reveal a significant risk reduction for any outcome parameter when polyunsaturated fat was increased in exchange for saturated fat .
The present systematic review provides no evidence ( moderate quality evidence ) for the beneficial effects of reduced/modified fat diets in the secondary prevention of coronary heart disease .
Recommending higher intakes of polyunsaturated fatty acids in replacement of saturated fatty acids was not associated with risk reduction