Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS)

Watts, G.F; Lewis, B; Lewis, E.S; Coltart, D.J; Smith, L.D.R; Swan, A.V; Brunt, J.N.H; Mann, J.I

doi:10.1016/0140-6736(92)90863-x

Cited by 843Lipoproteins and Cardiovascular HealthCholesterol and Lipid MetabolismCoronary Interventions and Diagnostics

Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS)

Watts, G.F, Lewis, B, Lewis, E.S, Coltart, D.J, Smith, L.D.R, Swan, A.V, Brunt, J.N.H, Mann, J.I·1992·The Lancet

DOI 10.1016/0140-6736(92)90863-x

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Abstract

To assess the effect of dietary reduction of plasma cholesterol concentrations on coronary atherosclerosis, we set up a randomised, controlled, end-point-blinded trial based on quantitative image analysis of coronary angiograms in patients with angina or past myocardial infarction. 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 randomised 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 L…

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From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [23]
Seven trials exhibited some concerns on RoB2, and 2 trials exhibited a high risk of bias.
“Seven trials exhibited some concerns (15), (19), (20), (21), (22), (24), (25), and 2 trials exhibited a high risk of bias (18), (23).”
From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [23]

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Authors: Watts, G. F., Lewis, B., Lewis, E. S., Coltart, D. J., Smith, L. D. R., Swan, A. V., Brunt, J. N. H., & Mann, J. I.
Affiliations: St Thomas' Hospital (GB)
University of Manchester (GB)
University of Otago (NZ)
ORCID: Watts, G.F
Lewis, B
Venue: The Lancet
Publisher: Elsevier BV
Published: 1992-03
Volume: 339
Issue: 8793
Pages: 563-569
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/0140-6736(92)90863-x
OpenAlex: W2132942256
Cited by: 843
References: 34
Citations by year: 2026: 2 · 2025: 4 · 2024: 9 · 2023: 8 · 2022: 4 · 2021: 5 · 2020: 8 · 2019: 6 · 2018: 9 · 2017: 7 · 2016: 9 · 2015: 10 · 2014: 10 · 2013: 15 · 2012: 11
FWCI: 103.88
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
Keywords: coronary artery disease, lipid-lowering diet, cholestyramine, dietary cholesterol reduction, coronary atherosclerosis regression, coronary angiography, coronary lumen diameter, LDL cholesterol, LDL/HDL ratio, cardiovascular events, hypercholesterolemia
MeSH terms: Angina Pectoris, Cholesterol, Cholestyramine Resin, Combined Modality Therapy, Coronary Artery Disease, Coronary Disease, Humans, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Remission Induction, Treatment Outcome, Coronary Angiography

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Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS)

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