Intensive lifestyle changes for reversal of coronary heart disease.
BACKGROUND
The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year.


OBJECTIVE
To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease.


METHODS
Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design.


METHODS
Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography.


METHODS
Two tertiary care university medical centers.


METHODS
Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years.


METHODS
Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events.


RESULTS
Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]).


CONCLUSIONS
More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.
Ornish
D
D
Department of Medicine, California Pacific Medical Center, San Francisco, USA. DeanOrnish@aol.com
Scherwitz
L W
LW
Billings
J H
JH
Brown
S E
SE
Gould
K L
KL
Merritt
T A
TA
Sparler
S
S
Armstrong
W T
WT
Ports
T A
TA
Kirkeeide
R L
RL
Hogeboom
C
C
Brand
R J
RJ
D000368:Aged; D000787:Angina Pectoris; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000517:prevention & control; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D004032:Diet; D018450:Disease Progression; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012657:Self-Help Groups; D016540:Smoking Cessation; D013315:Stress, Psychological / Q000517:prevention & control; D013997:Time Factors
D008055:Lipids