Intensive Lifestyle Changes for Reversal of Coronary Heart Disease

Published in Journal of the American Medical Association

Authors: Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ

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 per- cent 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.

Key Takeaways:

• The Lifestyle Heart Trial evaluated whether intensive lifestyle changes could stop or reverse the progression of heart disease
• In the initial 1-year study (see below) 82% of the treatment group showed measurable reversal of heart disease, as assessed by severity of atherosclerosis
• This 5-year follow up demonstrated greater regression in atherosclerosis among treatment group members compared to the 1-year results
• Patients in the treatment group sustained significant weight loss and decrease in LDL cholesterol (without lipid-lowering drugs) over the 5-year period and reported a 72% reduction in angina frequency
• After 5-years the treatment group averaged fewer than half as many cardiac events than the usual-care control group (0.89 vs. 2.25 events per patient, respectively)