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.
