human
***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: Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease , the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies . In this preliminary investigation of nutritional advice in a well population , subjects in one group practice were r and omized to receive either dietary instruction or simple follow up without instruction . The dietary recommendations were well received , and a substantial proportion of subjects reported altering their diets in accordance with them . There were modest beneficial changes in plasma lipid levels among men . Thus , using general practice as an avenue for promoting dietary change is feasible , and may be effective among men A preventive nursing intervention to reduce coronary heart disease ( CHD ) risk was tested . The sample was 19 families composed of 58 first-degreed relatives of young ( age 30 - 55 years ) victims of sudden cardiac death . Families were r and omly assigned to control and experimental groups . The intervention at 3 - 5 months postdeath focused on assessment of health history , health behaviors , health beliefs , informing and educating about CHD risk factors , and methods for detecting and reducing these factors . The control group received mailed question naires and no intervention . The subject 's reduction of CHD risk was measured at 7 months by changes in high risk CHD behaviors , changes in health beliefs , and adherence to screening for serum cholesterol and blood pressure determination . Analysis of covariance ( covarying age and pretest scores ) demonstrated no differences between groups for health beliefs ; however , significant differences for health beliefs existed between the sibling subgroups . The intervention was correlated with a significant reduction in alcohol intake . Reductions in high fat meat consumption were in the desired direction . Greater percentages of subjects in the intervention group obtained blood pressure and cholesterol screening 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 Background Significant regression of coronary and femoral atherosclerotic lesions has been documented by angiographic studies using aggressive lipid-lowering treatment . This study tested the applicability and effects of intensive physical exercise and low-fat diet on coronary morphology and myocardial perfusion in nonselected patients with stable angina pectoris . Methods and Results Patients were recruited after routine coronary angiography for stable angina pectoris ; they were r and omized to an  intervention group ( n = 56 ) and a  control group on “ usual care ” ( n = 57 ) . Treatment comprised intensive physical exercise in group training sessions ( minimum , 2 hr/wk ) , daily home exercise periods ( 20 min/d ) , and low-fat , low-cholesterol diet ( American Heart Association recommendation , phase 3 ) . No lipid-lowering agents were prescribed . After 12 months of participation , repeat coronary angiography was performed ; relative and minimal diameter reductions of coronary lesions were measured by digital image processing . Change in myocardial perfusion was assessed by 201TI scintigraphy . In patients participating in the intervention group , body weight decreased by 5 % ( p<0.001 ) , total cholesterol by 10 % ( p<0.001 ) , and triglycerides by 24 % ( p<0.001 ) ; high density lipoproteins increased by 3 % ( p = NS ) . Physical work capacity improved by 23 % ( p<0.0001 ) , and myocardial oxygen consumption , as estimated from maximal rate-pressure product , by 10 % , ( p<0.05 ) . Stress-induced myocardial ischemia decreased concurrently , indicating improvement of myocardial perfusion . Based on minimal lesion diameter , progression of coronary lesions was noted in nine patients ( 23 % ) , no change in 18 patients ( 45 % ) , and regression in 13 patients ( 32 % ) . In the control group , metabolic and hemodynamic variables remained essentially unchanged , whereas progression of coronary lesions was noted in 25 patients ( 48 % ) , no change in 18 patients ( 35 % ) , and regression in nine patients ( 17 % ) . These changes were significantly different from the intervention group ( p<0.05 ) . Conclusions In patients participating in regular physical exercise and low-fat diet , coronary artery disease progresses at a slower pace compared with a control group on usual care We have examined the independent and combined effects on blood pressure and blood lipids of alcohol restriction and weight loss in overweight male drinkers with a view to assessing overall effects on cardiovascular risk of two widely promoted nonpharmacological approaches for hypertension . Eighty-six men with a mean age of 44.3 years , a mean regular alcohol intake of 440 ml/wk ( five or six st and ard drinks per day ) , a mean blood pressure of 137.4 mm Hg systolic and 84.8 mm Hg diastolic , and a mean body mass of 92.5 kg entered a controlled two-way factorial study . The subjects were r and omly assigned to four groups for an 18-week intervention in which members of two groups drank only low-alcohol beer , thereby reducing their alcohol intake  by 374 ml/wk , while those of the other two groups continued their normal alcohol intake . Within the low and normal alcohol intake groups subjects either continued their usual diet or reduced their caloric intake by 4,200 - 6,300 kJ/day ( 1,000 - 1,500 kcal/day ) ( with protein , fat , and carbohydrate provided as 15 % , 30 % , and 55 % of total calories , respectively ) . Calorie reduction and alcohol restriction caused weight losses of 7.5 ( p less than 0.001 ) and 2.1 ( p less than 0.01 ) kg , respectively . Calorie reduction and alcohol restriction were associated with decreases in systolic blood pressure of 5.4 ( p less than 0.001 ) and 4.8 ( p less than 0.01 ) mm Hg , respectively , and in diastolic blood pressure of 4.2 ( p less than 0.001 ) and 3.3 ( p less than 0.01 ) mm Hg , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS This paper describes the planning and implementation of an individualized teaching programme for patients and their families following primary uncomplicated myocardial infa rct ion . This preliminary study was design ed and implemented by a senior nurse while working in the clinical area . Patients were r and omly allocated to a control or study group . Both groups of patients were interviewed on the fourth day following admission to hospital and again at 2 and 6 months after discharge . Nurse intervention in the form of individually planned consecutive teaching sessions achieved a reduction in anxiety and modification of identifiable risk factors ( smoking , obesity , diet , exercise ) in the patients included in the teaching programme PURPOSE This study was design ed to assess the long-term effects of low-fat diet and intensive physical exercise . METHODS Long-term efficacy of exercise and diet was assessed in 18 nonselected , fully employed patients with symptomatic coronary artery disease . Results were compared to 18 patients on usual care . RESULTS In the intervention group at 1 year , serum lipoproteins were brought to ideal levels , exercise-induced myocardial ischemia was significantly reduced , and progression in coronary atherosclerosis was retarded . After more than 5 years , patients in the intervention group showed a significant reduction in lipoprotein levels ( total cholesterol , 248 [ 179 - 299 ] vs 214 [ 173 - 272 ] mg/dL , P < .01 ; low density lipoprotein , 146 [ 83 - 216 ] , vs 152 [ 121 - 197 ] mg/dL , P < .005 vs control ; triglycerides ; 151 [ 80 - 303 ] mg/dl , vs 98 [ 46 - 182 ] mg/dL ; P < .005 ) and body mass index ( 26 + /- 2.9 vs 25.4 + /- 3.3 kg/m2 ; P < .05 ) . Exercise induced myocardial ischemia , measured by 201thallium scintigraphy , decreased by 29 % ( 41 degrees + /- 36 degrees vs 29 degrees + /- 29 degrees , P = NS ) and coronary atherosclerosis , assessed by angiography and digital image processing , progressed at a slower pace in light of a 21 % increase in physical work capacity ( 169 + /- 40 vs 205 + /- 50 , P < .01 ) and a 28 % increase in maximal rate pressure product ( 25 + /- 6 vs 32 + /- 4 , P < .004 ) . In contrast , patients in the control group showed only poorly controlled coronary risk factors ( total cholesterol , 243 [ 179 - 306 ] vs 26 [ 178 - 304 ] mg/dL , P = NS ; low density lipoprotein , 151 [ 79 - 229 ] vs 196 [ 107 - 238 ] mg/dL , P < .0005 vs intervention ; body mass index 25.7 + /- 2.5 vs 27.5 + /- 3.5 kg/m2 , P < .01 ) , whereas their physical work capacity tended to deteriorate ( 165 + /- 45 vs 142 + /- 62 Watts , P = not significant ) . CONCLUSIONS These data demonstrate that current usual care is insufficient in controlling risk factors of coronary artery disease . However , intensive physical exercise and low-fat diet remain an effective form of treatment after more than 5 years BACKGROUND Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study ( TOMHS ) , a 4-year , r and omized clinical trial ( N = 902 ) . This report describes the lifestyle intervention program used in TOMHS , presents data on the lifestyle changes observed , and focuses on the effect of weight loss on blood pressure and blood lipid levels . METHODS Participants were r and omly assigned to receive either placebo or one of five different antihypertensive medications . All took part in a lifestyle intervention program to reduce weight and sodium and alcohol intake  and to increase physical activity .  RESULTS Substantial changes from baseline levels were achieved for all lifestyle intervention variables . Mean weight change was -10.5 lb ( -5.6 % ) at 1 year , -8.5 lb ( -4.5 % ) at 2 years , -7.4 lb ( -4. 
    Output:
    
agent
***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: Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease , the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies . In this preliminary investigation of nutritional advice in a well population , subjects in one group practice were r and omized to receive either dietary instruction or simple follow up without instruction . The dietary recommendations were well received , and a substantial proportion of subjects reported altering their diets in accordance with them . There were modest beneficial changes in plasma lipid levels among men . Thus , using general practice as an avenue for promoting dietary change is feasible , and may be effective among men A preventive nursing intervention to reduce coronary heart disease ( CHD ) risk was tested . The sample was 19 families composed of 58 first-degreed relatives of young ( age 30 - 55 years ) victims of sudden cardiac death . Families were r and omly assigned to control and experimental groups . The intervention at 3 - 5 months postdeath focused on assessment of health history , health behaviors , health beliefs , informing and educating about CHD risk factors , and methods for detecting and reducing these factors . The control group received mailed question naires and no intervention . The subject 's reduction of CHD risk was measured at 7 months by changes in high risk CHD behaviors , changes in health beliefs , and adherence to screening for serum cholesterol and blood pressure determination . Analysis of covariance ( covarying age and pretest scores ) demonstrated no differences between groups for health beliefs ; however , significant differences for health beliefs existed between the sibling subgroups . The intervention was correlated with a significant reduction in alcohol intake . Reductions in high fat meat consumption were in the desired direction . Greater percentages of subjects in the intervention group obtained blood pressure and cholesterol screening 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 Background Significant regression of coronary and femoral atherosclerotic lesions has been documented by angiographic studies using aggressive lipid-lowering treatment . This study tested the applicability and effects of intensive physical exercise and low-fat diet on coronary morphology and myocardial perfusion in nonselected patients with stable angina pectoris . Methods and Results Patients were recruited after routine coronary angiography for stable angina pectoris ; they were r and omized to an  intervention group ( n = 56 ) and a  control group on “ usual care ” ( n = 57 ) . Treatment comprised intensive physical exercise in group training sessions ( minimum , 2 hr/wk ) , daily home exercise periods ( 20 min/d ) , and low-fat , low-cholesterol diet ( American Heart Association recommendation , phase 3 ) . No lipid-lowering agents were prescribed . After 12 months of participation , repeat coronary angiography was performed ; relative and minimal diameter reductions of coronary lesions were measured by digital image processing . Change in myocardial perfusion was assessed by 201TI scintigraphy . In patients participating in the intervention group , body weight decreased by 5 % ( p<0.001 ) , total cholesterol by 10 % ( p<0.001 ) , and triglycerides by 24 % ( p<0.001 ) ; high density lipoproteins increased by 3 % ( p = NS ) . Physical work capacity improved by 23 % ( p<0.0001 ) , and myocardial oxygen consumption , as estimated from maximal rate-pressure product , by 10 % , ( p<0.05 ) . Stress-induced myocardial ischemia decreased concurrently , indicating improvement of myocardial perfusion . Based on minimal lesion diameter , progression of coronary lesions was noted in nine patients ( 23 % ) , no change in 18 patients ( 45 % ) , and regression in 13 patients ( 32 % ) . In the control group , metabolic and hemodynamic variables remained essentially unchanged , whereas progression of coronary lesions was noted in 25 patients ( 48 % ) , no change in 18 patients ( 35 % ) , and regression in nine patients ( 17 % ) . These changes were significantly different from the intervention group ( p<0.05 ) . Conclusions In patients participating in regular physical exercise and low-fat diet , coronary artery disease progresses at a slower pace compared with a control group on usual care We have examined the independent and combined effects on blood pressure and blood lipids of alcohol restriction and weight loss in overweight male drinkers with a view to assessing overall effects on cardiovascular risk of two widely promoted nonpharmacological approaches for hypertension . Eighty-six men with a mean age of 44.3 years , a mean regular alcohol intake of 440 ml/wk ( five or six st and ard drinks per day ) , a mean blood pressure of 137.4 mm Hg systolic and 84.8 mm Hg diastolic , and a mean body mass of 92.5 kg entered a controlled two-way factorial study . The subjects were r and omly assigned to four groups for an 18-week intervention in which members of two groups drank only low-alcohol beer , thereby reducing their alcohol intake  by 374 ml/wk , while those of the other two groups continued their normal alcohol intake . Within the low and normal alcohol intake groups subjects either continued their usual diet or reduced their caloric intake by 4,200 - 6,300 kJ/day ( 1,000 - 1,500 kcal/day ) ( with protein , fat , and carbohydrate provided as 15 % , 30 % , and 55 % of total calories , respectively ) . Calorie reduction and alcohol restriction caused weight losses of 7.5 ( p less than 0.001 ) and 2.1 ( p less than 0.01 ) kg , respectively . Calorie reduction and alcohol restriction were associated with decreases in systolic blood pressure of 5.4 ( p less than 0.001 ) and 4.8 ( p less than 0.01 ) mm Hg , respectively , and in diastolic blood pressure of 4.2 ( p less than 0.001 ) and 3.3 ( p less than 0.01 ) mm Hg , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS This paper describes the planning and implementation of an individualized teaching programme for patients and their families following primary uncomplicated myocardial infa rct ion . This preliminary study was design ed and implemented by a senior nurse while working in the clinical area . Patients were r and omly allocated to a control or study group . Both groups of patients were interviewed on the fourth day following admission to hospital and again at 2 and 6 months after discharge . Nurse intervention in the form of individually planned consecutive teaching sessions achieved a reduction in anxiety and modification of identifiable risk factors ( smoking , obesity , diet , exercise ) in the patients included in the teaching programme PURPOSE This study was design ed to assess the long-term effects of low-fat diet and intensive physical exercise . METHODS Long-term efficacy of exercise and diet was assessed in 18 nonselected , fully employed patients with symptomatic coronary artery disease . Results were compared to 18 patients on usual care . RESULTS In the intervention group at 1 year , serum lipoproteins were brought to ideal levels , exercise-induced myocardial ischemia was significantly reduced , and progression in coronary atherosclerosis was retarded . After more than 5 years , patients in the intervention group showed a significant reduction in lipoprotein levels ( total cholesterol , 248 [ 179 - 299 ] vs 214 [ 173 - 272 ] mg/dL , P < .01 ; low density lipoprotein , 146 [ 83 - 216 ] , vs 152 [ 121 - 197 ] mg/dL , P < .005 vs control ; triglycerides ; 151 [ 80 - 303 ] mg/dl , vs 98 [ 46 - 182 ] mg/dL ; P < .005 ) and body mass index ( 26 + /- 2.9 vs 25.4 + /- 3.3 kg/m2 ; P < .05 ) . Exercise induced myocardial ischemia , measured by 201thallium scintigraphy , decreased by 29 % ( 41 degrees + /- 36 degrees vs 29 degrees + /- 29 degrees , P = NS ) and coronary atherosclerosis , assessed by angiography and digital image processing , progressed at a slower pace in light of a 21 % increase in physical work capacity ( 169 + /- 40 vs 205 + /- 50 , P < .01 ) and a 28 % increase in maximal rate pressure product ( 25 + /- 6 vs 32 + /- 4 , P < .004 ) . In contrast , patients in the control group showed only poorly controlled coronary risk factors ( total cholesterol , 243 [ 179 - 306 ] vs 26 [ 178 - 304 ] mg/dL , P = NS ; low density lipoprotein , 151 [ 79 - 229 ] vs 196 [ 107 - 238 ] mg/dL , P < .0005 vs intervention ; body mass index 25.7 + /- 2.5 vs 27.5 + /- 3.5 kg/m2 , P < .01 ) , whereas their physical work capacity tended to deteriorate ( 165 + /- 45 vs 142 + /- 62 Watts , P = not significant ) . CONCLUSIONS These data demonstrate that current usual care is insufficient in controlling risk factors of coronary artery disease . However , intensive physical exercise and low-fat diet remain an effective form of treatment after more than 5 years BACKGROUND Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study ( TOMHS ) , a 4-year , r and omized clinical trial ( N = 902 ) . This report describes the lifestyle intervention program used in TOMHS , presents data on the lifestyle changes observed , and focuses on the effect of weight loss on blood pressure and blood lipid levels . METHODS Participants were r and omly assigned to receive either placebo or one of five different antihypertensive medications . All took part in a lifestyle intervention program to reduce weight and sodium and alcohol intake  and to increase physical activity .  RESULTS Substantial changes from baseline levels were achieved for all lifestyle intervention variables . Mean weight change was -10.5 lb ( -5.6 % ) at 1 year , -8.5 lb ( -4.5 % ) at 2 years , -7.4 lb ( -4. 
    Output:
    