title: Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of <or=40% or >40% in the Multicenter Lifestyle Demonstration Project.
abstract: BACKGROUND
  Lifestyle changes are recommended for coronary heart disease (CHD) patients at risk for heart failure (HF) [ACC/AHA stage B; left ventricular ejection fraction (LVEF)<or=40%]. However, it is not clear whether changes in lifestyle are feasible and beneficial in these patients.
  
  
  OBJECTIVE
  To investigate the feasibility of intensive lifestyle changes for CHD patients at risk for HF.
  
  
  METHODS
  We compared 50 patients (18% female) with angiographically documented LVEF<or=40% (mean=33.4+/-7.3; range: 15-40%) to 186 patients (18% female) with LVEF>40% (mean=58.2+/-9.6; range: 42-87%), who were participants in the Multicenter Lifestyle Demonstration Project (MLDP). All were non-smoking CHD patients. The MLDP was a community-based, insurance-sponsored intervention (low-fat, plant-based diet; exercise; stress management) implemented at 8 sites in the US. Coronary risk factors, lifestyle and quality of life (SF-36) were assessed at baseline, 3 and 12 months.
  
  
  RESULTS
  Regardless of LVEF, patients showed significant improvements (all p<.05) in lifestyle behaviours, body weight, body fat, blood pressure, resting heart rate, total and LDL-cholesterol, exercise capacity, and quality of life by 3 months; most improvements were maintained over 12 months.
  
  
  CONCLUSIONS
  CHD patients at risk for heart failure with an LVEF<or=40%, can make changes in lifestyle to achieve similar medical and psychosocial benefit to patients with an LVEF>40%.
authors.affiliation: Preventive Medicine Research Institute (PMRI), Sausalito, CA, United States.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Pischke
authors.forename: Gerdi
authors.initials: G
authors.lastname: Weidner
authors.forename: Melanie
authors.initials: M
authors.lastname: Elliott-Eller
authors.forename: Dean
authors.initials: D
authors.lastname: Ornish
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology