TOPLINE:
In patients with chronic stable coronary artery disease (CAD), integrating intensive lifestyle modifications and goal-directed medical therapy — while reserving revascularization for those with severely reduced coronary flow capacity — resulted in improvements in risk factor scores and better clinical outcomes.
METHODOLOGY:
- Researchers in Texas conducted a single-center randomized trial to evaluate the efficacy of combining lifestyle modifications with aggressive medical therapy in patients with subclinical, suspected, or established CAD and factors that put them at a high risk for poor outcomes.
- Between 2009 and 2017, patients aged 40 years or older were randomly assigned to receive either comprehensive care (n = 513; mean age, 61 years; 67% men) or standard care (n = 515; mean age, 61 years; 69% men). After randomization, all patients underwent baseline stress-rest PET to quantify coronary flow capacity and accordingly defer or guide interventions.
- Comprehensive care involved intensive lifestyle counseling, regular review of PET results, and targeted steps toward prespecified risk factor goals. Patients also received frequent follow-ups and round-the-clock access to phone or email support. Those without severely reduced coronary flow capacity were managed without invasive interventions.
- Standard care involved no review of results or contact for support, and PET results were unblinded only for patients with severely reduced coronary flow capacity at a high risk for mortality to consider potential revascularization.
- The primary outcome was a change in the summed risk score of 16 individual risk factors over a 5-year follow-up period. Major adverse cardiac events, their components, and revascularization after 90 days were assessed as secondary outcomes.
TAKEAWAY:
- At 5 years, patients receiving comprehensive care had a lower summed risk score than those receiving standard care (difference in 5-year change, -1.4; P < .0001), along with significant improvements in individual risk factors such as low-density lipoprotein, BMI, and blood pressure (P < .01 for all).
- Over 11 years of extended follow-up, the comprehensive care group had 31.4% fewer major adverse cardiac events, 42.7% fewer deaths, 37% fewer deaths or myocardial infarction events, and 35.1% fewer revascularizations than the standard care group (P < .05 for all).
- Only 5.4% of patients underwent revascularization within 90 days, which was primarily guided by the severity of coronary flow capacity.
IN PRACTICE:
“The randomized, controlled, blinded 5-year CENTURY trial demonstrates that participants for whom invasive coronary procedures were safely deferred based on [coronary flow capacity] by PET, integrated with comprehensive, intense lifestyle modifications, and aggressive medical treatment targeted to goals significantly improved all risk factor scores with significant reduction in all-cause mortality,” the researchers reported.
“Review of risk factor data, PET images, and frequent supportive participant contact with CENTURY [trial] research staff appeared to enhance adherence of the comprehensive compared with the standard care group,” they added.
SOURCE:
This study was led by K. Lance Gould, MD, of the University of Texas McGovern Medical School in Houston. It was published online on May 29, 2025, in European Heart Journal.
LIMITATIONS:
This study was conducted at a single center. About 23% of patients did not participate in the follow-up visits or PET scans. Blinding coronary artery calcium and myocardial perfusion images in patients receiving standard care might have been a source of bias.
DISCLOSURES:
This study received support from the Weatherhead PET Centre endowment at the University of Texas-Houston. One author reported receiving internal funding from the funding source and being an applicant for FDA-cleared K231731 PET software. One author reported serving as the principal investigator of a trial which receives support from a medical device company. Several authors reported donating any personal honoraria or waiving off their rights to royalties to avoid conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.