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Pischke C.R.,Dana-Farber Cancer Institute | Pischke C.R.,Bremen Institute for Prevention Research and Social Medicine | Elliott-Eller M.,Quality Assessment Performance Improvement | Li M.,State University of New York at Stony Brook | And 4 more authors.
Journal of Cardiovascular Nursing | Year: 2010

Background and Research 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. Subject and 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 ≤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. Results and Conclusion: 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. Copyright © 2010 Wolters Kluwer Health.

Gage A.,Preventive Medicine Research Institute
Topics in Geriatric Rehabilitation | Year: 2011

Clinical trials studied Yoga-based lifestyle changes on coronary artery disease patients during the 1970s to early 1990s. Study components included exercise, vegetarianism, Yoga practices, meditation, and a structured group meeting. For almost 25 years, the Research Participants have continued meeting regularly and have reported improved health, better relationships, quicker recoveries, creativity, joie de vivre, and longevity. They continue to experience benefits from this Yoga-based lifestyle for treatment of disease by maintaining a Sangha: a circle of friends, an enduring group circle for coronary artery disease patients. Copyright © 2011 Lippincott Williams & Wilkins.

Pischke C.R.,Dana-Farber Cancer Institute | Frenda S.,Preventive Medicine Research Institute | Ornish D.,Preventive Medicine Research Institute | Weidner G.,San Francisco State University | Weidner G.,Johannes Gutenberg University Mainz
Psychology and Health | Year: 2010

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale - Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs. © Taylor & Francis.

Dod H.S.,West Virginia University | Bhardwaj R.,West Virginia University | Sajja V.,West Virginia University | Weidner G.,San Francisco State University | And 10 more authors.
American Journal of Cardiology | Year: 2010

Intensive lifestyle changes have been shown to regress atherosclerosis, improve cardiovascular risk profiles, and decrease angina pectoris and cardiac events. We evaluated the influence of the Multisite Cardiac Lifestyle Intervention Program, an ongoing health insurance-covered lifestyle intervention conducted at our site, on endothelial function and inflammatory markers of atherosclerosis in this pilot study. Twenty-seven participants with coronary artery disease (CAD) and/or risk factors for CAD (nonsmokers, 14 men; mean age 56 years) were enrolled in the experimental group and asked to make changes in diet (10% calories from fat, plant based), engage in moderate exercise (3 hours/week), and practice stress management (1 hour/day). Twenty historically (age, gender, CAD, and CAD risk factors) matched participants were enrolled in the control group with usual standard of care. At baseline endothelium-dependent brachial artery flow-mediated dilatation (FMD) was performed in the 2 groups. Serum markers of inflammation, endothelial dysfunction, and angiogenesis were performed only in the experimental group. After 12 weeks, FMD had improved in the experimental group from a baseline of 4.23 ± 0.13 to 4.65 ± 0.15 mm, whereas in the control group it decreased from 4.62 ± 0.16 to 4.48 ± 0.17 mm. Changes were significantly different in favor of the experimental group (p <0.0001). Also, significant decreases occurred in C-reactive protein (from 2.07 ± 0.57 to 1.6 ± 0.43 mg/L, p = 0.03) and interleukin-6 (from 2.52 ± 0.62 to 1.23 ± 0.3 pg/ml, p = 0.02) after 12 weeks. Significant improvement in FMD, C-reactive protein, and interleukin-6 with intensive lifestyle changes in the experimental group suggests ≥1 potential mechanism underlying the clinical benefits seen in previous trials. © 2010 Elsevier Inc. All rights reserved.

Chainani-Wu N.,Preventive Medicine Research Institute | Chainani-Wu N.,University of California at San Francisco | Weidner G.,Preventive Medicine Research Institute | Weidner G.,San Francisco State University | And 8 more authors.
American Journal of Cardiology | Year: 2010

Cross-sectional studies have reported inverse associations of B-type natriuretic peptide (BNP) with the body mass index (BMI). We evaluated whether changes in the BMI are associated with changes in BNP. A nested prospective cohort study of a lifestyle intervention (low-fat, whole-foods diet, exercise, stress management, and social support) was conducted. BNP, BMI, and other biomarkers were measured at baseline and 3 months. A total of 131 subjects, 56 with coronary heart disease (CHD) and 75 at high risk, with ≥3 CHD risk factors and/or diabetes mellitus, were enrolled. At 3 months, the mean BMI had decreased (34.4 to 31.7 kg/m2, p <0.001), BNP had increased (median 18 to 28 pg/ml, p <0.001), and low-density lipoprotein, C-reactive protein, apolipoprotein B (all p <0.002), and angina frequency (p = 0.017) and severity (p = 0.052) had decreased. The subjects' physical limitations had decreased and their physical functioning had improved (all p <0.001). The percentage of change in BNP was inversely associated with the percentage of change in insulin (r = -0.339, p = 0.005, n = 63 nondiabetics). It was also inversely associated with the percentage of change in BMI (r = -0.28, p = 0.002, n = 116), and this association remained significant (p = 0.029) in multiple regression analyses controlling for age, gender, CHD, diabetes mellitus, percentage of change in lifestyle index, and β-blocker use. The metabolic changes related to adipose tissue lipolysis could explain these findings. In conclusion, BNP increased in subjects experiencing weight loss while following a lifestyle intervention, and angina pectoris, physical limitations, and other CHD risk factors decreased. Therefore, in this context, increasing BNP might not indicate worsening disease or a worsening prognosis. Thus, the proposed use of BNP in monitoring disease progression should take into account changes in the BMI during the same period. © 2010 Elsevier Inc. All rights reserved.

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