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AMERICAN MEDICAL ASSOCIATION

Physicians dedicated to the health of America

Long-Term Lifestyle Changes Increase Regression of Coronary Heart Disease.

Coronary atherosclerosis continued to progress in those with conventional lifestyle.

CHICAGO — Patients in an experimental group who made intensive changes in diet, exercise, stress management, and other lifestyle factors showed greater reversal of coronary heart disease after five years than after one year in the Lifestyle Heart Trial, according to an article in the December 16 issue of The Journal of the American Medical Association (JAMA).

In contrast, the authors found that control group patients showed much more progression (continued worsening) in average percent diameter stenosis after five years than after one year, even though more than half of the control group patients were prescribed lipid-lowering medications during the course of the study.

Dean Ornish, M.D., of the Preventive Medicine Research Institute, Sausalito, Calif., and the University of California at San Francisco School of Medicine, and colleagues conducted a five-year follow-up of the Lifestyle Heart Trial. The original trial found that after one year, heart patients who made intensive lifestyle changes had a 37.2 percent reduction in LDL cholesterol, less frequent angina, and a reduction in stenosis. By contrast, patients who made moderate changes reduced LDL cholesterol by only 6 percent, had more frequent angina, and greater narrowing of the blood vessels. Among the 48 patients from the original study, 35 agreed to take part in the follow-up and continued thought the entire five years.

Patients in the experimental group were prescribed an intensive program that included a 10 percent fat vegetarian diet, moderate exercise, stress management training, smoking cessation, and group psychosocial support. Control group patients were asked to follow the advice of their personal physicians regarding lifestyle changes, consistent with the American Heart Association’s Step II diet guidelines. No experimental group patients took lipid-lowering drugs, while 60 percent of control patients received lipid-lowering medication. Angiograms were done at the end of the five years for the 20 experimental group and 15 control patients who completed the follow-up.

Among the findings of the study:

Experimental group patients had a 91 percent reduction in frequency of angina after one year and a 72 percent reduction after five years. Control patients had a 186 percent increase after one year, and a 36 percent decrease after five years. Three of the five control patients who reported an increase from baseline to year one underwent coronary angioplasty before year five. The reduction in LDL cholesterol levels in the experiment group was comparable with results achieved by lipid –lowering drugs for ambulatory patients.

In the experiment group, the average percent diameter stenosis (narrowing of the blood vessels) showed a 7.9 percent relative improvement after five years, while the control group showed a 27.7 percent relative worsening.

The researchers also found more than twice as many cardiac events in the control group (45 events, 2.25 events per patient) than in the experimental group (25 events, 0.89 events per patients). Events included heart attacks, coronary angioplasty, coronary bypass surgery, cardiac-related hospitalizations, and cardiac-related deaths.

The authors write: “These finding support the feasibility of intensive lifestyle changes in delaying, stopping, or reversing the progression of coronary artery disease in ambulatory patients over prolonged periods.”

The author conclude: “In summary, these ambulatory patients were able to make and maintain comprehensive changes in diet and lifestyle for five years and showed even more regression of coronary atherosclerosis after five years than after one year as measured by percent diameter stenosis. In contrast, patients following more conventional lifestyle recommendations showed even more progression of coronary atherosclerosis after five years than after one year, and had more than twice as many cardiac events as patients making comprehensive lifestyle changes.”

(JAMA. 1998;280:2001-2007)

Editor’s Note: The Preventive Medicine Research Institute is a non-profit organization. Major support for this study was provided by grants from the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland and numerous other organizations. For a complete listing, please see the JAMA article.