title: Clinical events in coronary heart disease patients with an ejection fraction of 40% or less: 3-year follow-up results.
abstract: OBJECTIVE
  It is unclear whether lifestyle changes can delay the need for surgical procedures in coronary heart disease (CHD) patients with asymptomatic reduced left ventricular ejection fraction (LVEF). The aim of this pilot study was to examine whether lifestyle changes can delay the need for surgical procedures in this population.
  
  
  METHODS
  We compared 3-year clinical events in 27 CHD patients eligible to receive revascularization (by insurance standards), but underwent lifestyle changes (low-fat diet, exercise, stress management) instead (intervention group [IG], LVEF < or =40%), with those of a historically matched (age, gender, LVEF, and stenosis of the 3 major coronary arteries) control group receiving usual care (UCG; n = 13) who received revascularization at study entry. Both IG and UCG patients were enrolled in the health insurance companies participating in the Multicenter Lifestyle Demonstration Project, an insurance-sponsored, community-based, secondary prevention study implemented at 8 hospital sites in the United States.
  
  
  CONCLUSIONS
  At 3 months, there were more cardiac events in the UCG (6 events) than in the IG (1 event; P < .006; odds ratio = 13.27; confidence interval = 1.57-111.94). This difference was maintained over 3 years (P < .06; odds ratio = 2.75; confidence interval = 1.05-7.19). Of the 26 surviving (1 cardiac death) IG patients, 23 did not require primary revascularization. In conclusion, CHD patients with asymptomatic reduced LVEF may be able to safely delay revascularization by making changes in lifestyle with no increased risk for cardiac events or overt heart failure over 3 years.
authors: Harvard School of Public Health, Dana-Farber Cancer Institute, Boston, MA, USA. pischcl@gmx.net
authors: Claudia R
authors: CR
authors: Pischke
authors: Melanie
authors: M
authors: Elliott-Eller
authors: Minmin
authors: M
authors: Li
authors: Nancy
authors: N
authors: Mendell
authors: Dean
authors: D
authors: Ornish
authors: Gerdi
authors: G
authors: Weidner
mesh_terms: D017130:Angioplasty / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D004032:Diet; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology*; D010865:Pilot Projects; D013315:Stress, Psychological / Q000517:prevention & control; D013318:Stroke Volume / Q000502:physiology*; D014481:United States / Q000453:epidemiology