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Ornish study shows lifestyle changes reverse heart disease

Lifestyle matters. Especially to heart patients. Those are the findings of a new study by Dr. Dean Ornish in which an experimental group who made intensive changes in diet, exercise, stress management and other lifestyle factors, including yoga, showed greater reversal of coronary heart disease after five years than patients who followed a program advocated by the American Heart Association. In fact, the control group got worse over the five years, even though half of them were on lipid-lowering medications.

The study was a follow-up to the groundbreaking Ornish's 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 ("bad" cholesterol), less frequent angina (chest pain), and a reduction in stenosis (narrowing of the blood vessels). By contrast, patients who made moderate changes reduced LDL cholesterol by only 6 percent, had more frequent angina, and greater stenosis. Among the 48 patients from the original study, 35 agreed to take part in the follow-up and continued through the entire five years.

Patients in the experimental group were prescribed an intensive program that included a 10 percent fat vegetarian diet, moderate aerobic 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 five years for the 20 experimental group patients and 15 control group 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 in frequency of angina 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 experimental group, the average percent diameter stenosis 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 patient). Events included heart attacks, coronary angioplasty, coronary bypass surgery, cardiac-related hospitalizations and cardiac-related deaths.

The bottom line for the study is that major lifestyle changes can help reverse heart disease. Following the program recommended by the American Heart Association does not.

Interestingly, in news reports following publication of the study the American Heart Association refused to endorse its results, saying that the Ornish program was too difficult for most people to follow, while their program was easier. Apparently, the fact that you also have a higher chance of dying if you follow the Heart Association's program doesn't factor into their thinking.

From "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease," by Dean Ornish, MD; Larry W. Scherwitz, PhD; James H. Billings, PhD, MPH; K. Lance Gould, MD; et al, in the Journal of the American Medical Association, December 16, 1998.

 

 

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