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Intensive lifestyle changes for reversal of coronary heart disease.

Abstract

CONTEXT

The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year.

OBJECTIVES

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.

DESIGN

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

PATIENTS

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.

SETTING

Two tertiary care university medical centers.

INTERVENTION

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

MAIN OUTCOME MEASURES

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.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, California Pacific Medical Center, San Francisco, USA. DeanOrnish@aol.com

    , , , , , , , , , ,

    Source

    JAMA 280:23 1998 Dec 16 pg 2001-7

    MeSH

    Aged
    Angina Pectoris
    Coronary Angiography
    Coronary Artery Disease
    Coronary Disease
    Diet
    Disease Progression
    Exercise
    Feasibility Studies
    Female
    Health Behavior
    Humans
    Life Style
    Lipids
    Male
    Middle Aged
    Risk Factors
    Self-Help Groups
    Smoking Cessation
    Stress, Psychological
    Time Factors

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    9863851

    Citation

    Ornish, D, et al. "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease." JAMA, vol. 280, no. 23, 1998, pp. 2001-7.
    Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-7.
    Ornish, D., Scherwitz, L. W., Billings, J. H., Brown, S. E., Gould, K. L., Merritt, T. A., ... Brand, R. J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 280(23), pp. 2001-7.
    Ornish D, et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998 Dec 16;280(23):2001-7. PubMed PMID: 9863851.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Intensive lifestyle changes for reversal of coronary heart disease. AU - Ornish,D, AU - Scherwitz,L W, AU - Billings,J H, AU - Brown,S E, AU - Gould,K L, AU - Merritt,T A, AU - Sparler,S, AU - Armstrong,W T, AU - Ports,T A, AU - Kirkeeide,R L, AU - Hogeboom,C, AU - Brand,R J, PY - 1998/12/24/pubmed PY - 2001/8/14/medline PY - 1998/12/24/entrez SP - 2001 EP - 7 JF - JAMA JO - JAMA VL - 280 IS - 23 N2 - CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. OBJECTIVES: 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. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: 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. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: 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. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/9863851/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/280/pg/2001 DB - PRIME DP - Unbound Medicine ER -