Lifestyle Changes Boost Medical Therapy for CAD

By Admin

11 Jun, 2025

A New Paradigm in CAD Treatment

For patients with chronic stable coronary artery disease (CAD), a groundbreaking study has revealed that combining intensive lifestyle changes with aggressive medical therapy while reserving invasive procedures only for those with significantly reduced coronary flow capacity can dramatically improve clinical outcomes. This holistic treatment strategy, as opposed to traditional approaches centered on early revascularization, marks a shift toward personalized, non-invasive cardiac care.

Inside the CENTURY Trial

Conducted at a single center in Texas, the randomized CENTURY trial evaluated 1,028 patients aged 40 and above from 2009 to 2017. Participants were randomized into two groups:

• Comprehensive care (n = 513) involved intensive lifestyle counseling, regular follow-up, PET-based risk reviews, 24/7 support, and strict adherence to risk factor goals.
  
  

• Standard care (n = 515) excluded these interventions, with invasive procedures considered only for those at the highest mortality risk based on severely reduced coronary flow capacity.
  
  

Each participant underwent baseline stress-rest PET scans to quantify coronary flow, which helped guide subsequent clinical decisions.

Remarkable Results at 5 Years and Beyond

Over a 5-year follow-up period, patients receiving comprehensive care demonstrated significantly lower risk factor scores compared to those in standard care (difference in score: -1.4; P < .0001). Improvements were particularly evident in low-density lipoprotein (LDL), body mass index (BMI), and blood pressure each crucial markers in cardiovascular health.

During an 11-year extended observation, the results were even more compelling:

• 31.4% reduction in major adverse cardiac events
  
  

• 42.7% fewer deaths from all causes
  
  

• 37% fewer incidents of death or myocardial infarction
  
  

• 35.1% lower rate of revascularization procedures
  These results emphasize the long-term efficacy of deferring invasive procedures when coronary flow capacity is preserved.
  
  

A Personalized, Support-Driven Model

Researchers reported that frequent contact with the care team and regular review of patient data including PET imaging helped enhance adherence in the comprehensive care group. Only 5.4% of patients underwent revascularization within 90 days, and those decisions were based strictly on coronary flow severity.

Expert Commentary and Practical Implications

“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,” researchers noted.

Study Source and Considerations

Published in the European Heart Journal on May 29, 2025, the study was led by Dr. K. Lance Gould of the University of Texas McGovern Medical School in Houston. The trial received funding from the Weatherhead PET Centre endowment, with full transparency on potential conflicts of interest.

However, limitations included its single-center design and the 23% attrition in follow-up visits or PET scans. The lack of blinding in coronary imaging for the standard care group could also introduce bias.

A Heartfelt Conclusion

This research reinforces the power of combining lifestyle changes with personalized, data-driven therapy to combat chronic CAD. Rather than rushing to invasive procedures, this approach focuses on long-term wellness setting a new gold standard in cardiac care.