Lifestyle Changes Help Heart Patients, Study Says

Making dramatic lifestyle changes, including consuming a diet of less than 10% fat, can lead to long-term improvements in patients with heart disease, according to the latest research by the well-known guru of prevention, Dr. Dean Ornish.

In a follow-up to his ground-breaking study published in 1990, which showed a decline in heart disease markers after one year of lifestyle changes, Ornish now has data from a small group of 20 patients who stuck to the program for five years.

The follow-up, published in today’s Journal of the American Medical Assn., shows continued improvement in people who adhere to the strict regimen of relaxation techniques, exercise, yoga, dietary changes and support group meetings.

A comparison group of 15 cardiac patients who followed the more typical treatment protocol for coronary artery disease, which for some people included medication, worsened over the five years.

Evidence that the progression of heart disease can be altered through aggressive lifestyle changes was praised by medical experts. But some noted that the study does not resolve a pivotal question: Just how many people can painstakingly overhaul their health habits?

“It’s a very difficult task to get people to follow this program,” said Dr. Robert H. Eckel, volunteer chairman of the American Heart Assn.’s nutrition committee and a University of Colorado professor. “There are small numbers of people in this study, and that is because it is so hard to get people to do this.”

But Ornish, who operates the Preventive Medicine Research Institute in Sausalito, Calif., and is the author of several books on overcoming heart disease, said his latest study shows that aggressive, nonmedical intervention is a reasonable option for some patients.

He said the study size was small in part because only half the people invited to participate agreed to do so. Most declined because they didn’t want to make intensive lifestyle changes or did not want to undergo further medical testing. He said, however, that the study was large enough to demonstrate dramatic differences depending on the approach used.

“I think it is . . . important that the control group got worse even though they were following the American Heart Assn. guidelines and some were even taking cholesterol-lowering drugs,” Ornish said. “The message here is that even if people make moderate changes they are likely to get worse. If they are willing to make bigger changes, they are likely to get better and better.”

The Lifestyle Heart Trial followed 48 patients from 1986 to 1992. Eight patients dropped out of the experimental group and five from the control group during the study period.

Ornish and his colleagues from UC San Francisco, the University of Texas and elsewhere found that patients in the experimental group experienced a modest 3.1% reduction of blockage in the coronary arteries after five years, while the control group averaged an 11.8% worsening of blockage.

Other measures were also more positive for the experimental group, such as a decrease in low-density lipoprotein cholesterol--the “bad” kind--and angina. Moreover, the control group experienced more than twice as many cardiac “events,” such as heart attacks, bypass surgery, hospitalizations due to heart disease and death, compared to the Ornish regimen group.

“This confirms that even small changes in [blockage] produce a great reduction in cardiac events,” Ornish said.

However, the study has several shortcomings, Eckel said. Besides the small number of subjects, he said, the individuals in the control group were not representative of typical cardiac patients, as the paper claims.

“The people in the control group were inadequately treated,” Eckel said. Those people had elevated LDL cholesterol levels, he said, and most physicians would intervene with more aggressive treatment if cholesterol levels remained too high over time.

Eckel also questioned whether the control group subjects closely abided by the heart association dietary guidelines. According to Ornish, the patients in the control group followed what is known as the AHA Step 11 diet of no more than 30% calories from fat and no more than 7% of those calories from saturated fat.

In any case, the study will probably contribute to a debate among health experts over dietary guidelines that make comparatively mild recommendations, said Dr. David Heber, director of the UCLA Center for Human Nutrition.

“This is a wake-up call to the typical physician who says, ‘Just cut your fat to 30% and you’ll be fine.’ This study will take its place with other studies in the literature that suggest we need to do more than that.”

Will People Want to Change?

But can Americans adhere to a diet of sparse amounts of butter and meat and loads of fruits and vegetables, not to mention the other components Ornish says are necessary, such as daily exercise, meditation, a supportive environment and abstinence from drugs, alcohol and tobacco?

“We need to create recommendations that can be followed by the general public,” said Eckel, in an official statement released by the American Heart Assn. “While these results are useful, they have not been confirmed by a large study, involving thousands of patients, which will be necessary before any public health recommendations can be made.”

Overall, Ornish said, the motivation of the patients he studied remained very high in adhering to the lifestyle changes long term.

“It’s paternalistic to say, ‘We know you can’t change your lifestyle, don’t even try,’ ” Ornish said. “Not everyone wants to make bigger changes, but I do think people deserve to have the information to make informed and intelligent decisions. The fact is, most people are willing to choose diet and lifestyle changes rather than take medication and have surgery.”

In another study directed by Ornish, published Nov. 19 in the American Journal of Cardiology, he found that 78% of 194 people who were eligible for bypass or angioplasty were able to stay on his regimen and avoid surgery for at least three years--and without increasing their risk of cardiac events. The study was carried out without Ornish’s direct involvement (unlike today’s study in which people were counseled by Ornish) at 15 sites around the country.