The DOI matches its Crossref record; 3 of the 3 references it cites were found in a registry or an index.
Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS)
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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“Only 3 studies were on stroke (20), (23), (25), and the incidence of stroke was almost zero in 2 of those studies (23), (25).”
From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [23]
In the citing paper
“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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Cites
Brown, G., Albers, J. J., Fisher, L. D., Schaefer, S. M., Lin, J.-T., Kaplan, C., Zhao, X.-Q., Bisson, B. D., Fitzpatrick, V. F., & Dodge, H. T. (1990) · New England Journal of Medicine · doi:10.1056/nejm199011083231901 · Cited by 2,159
Can lifestyle changes reverse coronary heart disease?
Ornish, D., Brown, S. E., Billings, J. H., Scherwitz, L. W., Armstrong, W. T., Ports, T. A., McLanahan, S. M., Kirkeeide, R. L., Gould, K. L., & Brand, R. J. (1990) · The Lancet · doi:10.1016/0140-6736(90)91656-u · Cited by 2,110
Buchwald, H., Varco, R. L., Matts, J. P., Long, J. M., Fitch, L. L., Campbell, G. S., Pearce, M. B., Yellin, A. E., Edmiston, W. A., Smink, R. D., et al. (1990) · New England Journal of Medicine · doi:10.1056/nejm199010043231404 · Cited by 1,001
Research works printed but not linked: 28
- Study Group, 1988, The treatment of hyperlipidaemia in adults. Recommendations of the European Atherosclerosis Society, Eur Heart J, 8, 277
- Duffield, 1983, Treatment of hyperlipidaemia retards progression of symptomatic femoral atherosclerosis, Lancet, ii, 639, 10.1016/S0140-6736(83)92527-8 · DOI
- Amtzenius, 1985, Diet, lipoproteins, and the progression of coronary atherosclerosis, N Engl J Med, 312, 805, 10.1056/NEJM198503283121301 · DOI
- Blankenhom, 1990, The influence of diet on the appearance of new lesions in human coronary arteries, JAMA, 263, 1646, 10.1001/jama.263.12.1646 · DOI
- Lewis, 1974, Serum lipoprotein abnormalities in patients with ischaemic heart disease: comparisons with a control population, Br Med J, iii, 489, 10.1136/bmj.3.5929.489 · DOI
- Campeau, 1976, Grading of angina pectoris, Circulation, 54, 522, 10.1161/circ.54.3.947585 · DOI
- Austen, 1975, AHA committee report. A reporting system on patients evaluated for coronary artery disease, Circulation, 51, 7, 10.1161/01.CIR.51.4.5 · DOI
- Colchester, 1983, Measurement of vessel calibre and volume blood flow by dynamic quantitative digital angiography: an initial application showing variation of cerebral artery diameter with PaCO2, J Cerebr Blood Flow Metab, 3, S640
- Jnh Brunt, Design, implementation, validation and use of a system for quantitative coronary cineangiography ((Rotterdam, 1989) 32 (abstr)), Third international symposium on coronary arteriography.
- Brown, 1982, Arteriographic assessment of coronary atherosclerosis, Arteriosclerosis, 2, 2, 10.1161/01.ATV.2.1.2 · DOI
- Crawford, 1977, Computer densitometry for angiographic assessment of arterial cholesterol content and gross pathology in human atherosclerosis, J Lab Clin Med, 89, 378
- Blankenhorn, 1991, Effects of colestipolniacin therapy on human femoral atherosclerosis, Circulation, 83, 438, 10.1161/01.CIR.83.2.438 · DOI
- Blankenhorn, 1987, Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts, JAMA, 257, 3233, 10.1001/jama.257.23.3233 · DOI
- Kane, 1990, Regression of coronary atherosclerosis during treatment of familial hypercholesterolaemia with combined drug regimens, JAMA, 264, 1007, 10.1001/jama.264.23.3007 · DOI
- Wissler, 1976, Studies of regression of advanced atherosclerosis in experimental animals and men, Ann NY Acad Sci, 275, 363, 10.1111/j.1749-6632.1976.tb43368.x · DOI
- La Ville, 1989, Primary prevention of atherosclerosis by lovastatin in a genetically hyperlipidaemic rabbit strain, Atherosclerosis, 78, 205, 10.1016/0021-9150(89)90224-4 · DOI
- Habib, 1984, Atherosclerosis impairs endothelium-dependent arterial relaxation, Circulation, 70, 123
- Vita, 1990, Coronary vasomotor response to acetylcholine relates to risk factors for coronary artery disease, Circulation, 81, 491, 10.1161/01.CIR.81.2.491 · DOI
- Harrison, 1987, Restoration of endothelium-dependent arterial relaxation by dietary treatment of atherosclerosis, Circulation, 80, 1808
- Vartiainen, 1947, Arteriosclerosis and wartime, Ann Med Intern Fen, 34, 705
- Wilens, 1947, The resorption of arterial atheromatous deposits in wasting disease, Am J Pathol, 33, 793
- Lewis, 1981, Towards an improved lipid-lowering diet: additive effects of changes in nutrient intake, Lancet, ii, 1310, 10.1016/S0140-6736(81)91339-8 · DOI
- Choudhury, 1984, A multifactorial diet in the management of hyperlipidaemia, Atherosclerosis, 50, 93, 10.1016/0021-9150(84)90011-X · DOI
- Lipid Research Clinics Program, 1984, The Lipid Research Clinics coronary primary prevention trial results, I. Reduction in incidence of coronary heart disease, JAMA, 251, 351, 10.1001/jama.251.3.351 · DOI · Paper page
- Brensike, 1984, Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI type II coronary intervention study, Circulation, 69, 313, 10.1161/01.CIR.69.2.313 · DOI
- Ambrose, 1988, Angiographic progression of coronary artery disease and the development of myocardial infarction, J Am Coll Cardiol, 12, 56, 10.1016/0735-1097(88)90356-7 · DOI
- Hackett, 1989, Coronary stenoses before and after acute myocardial infarction, Am J Cardiol, 63, 1517, 10.1016/0002-9149(89)90018-0 · DOI
- Roussouw, 1990, The value of lowering cholesterol after myocardial infarction, N Engl J Med, 323, 1112, 10.1056/NEJM199010183231606 · DOI
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Cleland, J. (1996) · doi:10.1007/978-94-011-5406-2_15
Brown, B. G., Zhao, X. Q., Poulin, D., & Albers, J. J. (1995) · Springer eBooks · doi:10.1007/978-1-4615-1959-1_1
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Hirsch, L. J. (1995) · Medical science symposia series · doi:10.1007/978-94-011-0039-7_39
Coronary atherosclerosis intervention trials using serial quantitative angiography
Vos, J., & de Feyter, P. J. (1994) · Developments in cardiovascular medicine · doi:10.1007/978-94-015-8358-9_35
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Metadata
- 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
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1992-03
- Volume
- 339
- Issue
- 8793
- Pages
- 563-569
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- 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
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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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