Prof. Alain Cohen Solal
The PET study recently showed that a regular exercise training program has the same beneficial effect on cardiovascular hard end-points than a PTCA-based strategy, with a greater improvement in exercise capacity, at a lesser cost.
PTCA with stenting is the widely accepted reference treatment for patients with stable angina pectoris and simple, dilatable lesions.
Aspirin, statins, ACE-I are now widely used in secondary prevention in these patients. These improvements in medical treatment may lead both patients and physicians to overlook the role of risk factor control by behaviour changes. It has long been known that regular exercise has various beneficial effects in these patients via improvement in coronary vasodilation (1), perhaps preconditioning effect, increase in insulin sensitivity and HDL levels, decrease in inflammation modulators etc… However, there has been no head to head comparison between exercise training and interventional cardiology in these patients.
The PET study (2) was recently conducted in 101 patients randomised to PTCA+stenting or to entrance in a training programme. It showed that a regular exercise training programme may have the same beneficial effect on cardiovascular hard end-points (3) than a PTCA-based strategy, with a greater improvement in exercise capacity, at a lesser cost. There was no difference not only in angina scores, but also in the exetnt of exercise-induced myocardial ischemia evaluated by myocardial scintigraphy. And no more acute ischemic episodes in the training group.
This first study shows the importance of carefully evaluating our interventional procedures. It should lead us not to forget that coronary atherosclerosis is a long and complex process that cannot be solely "cured" by a single, short, interventional procedure. There is room here for behaviour modifications, especially by promoting more exercise in daily life.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
1. Hambrecht R. N Engl J Med 2000; Effect of exercise on coronary endothelial function in patients with coronary artery disease. 342:454-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10675425
2. Hambrecht R et coll. Circulation Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. 2004, 109, 1371-8 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15007010
3. AVERT Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. Atorvastatin versus Revascularization Treatment Investigators. New Engl J Med 1999, 341, 70-6 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10395630
Prof. A. Cohen Solal Clichy, France Vice President of the Working Group on Cardiac Rehabilitation and Exercise Physiology
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