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1.
Ornish DM, Scherwitz LW, Doody RS.  et al.  Effects of stress management training and dietary changes in treating ischemic heart disease.  JAMA.1983;249:54-59.Google Scholar
2.
Ornish DM, Gotto AM, Miller RR.  et al.  Effects of a vegetarian diet and selected yoga techniques in the treatment of coronary heart disease [abstract].  Clin Res.1979;27:720A.Google Scholar
3.
Ornish DM, Brown SE, Scherwitz LW.  et al.  Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial.  Lancet.1990;336:129-133.Google Scholar
4.
Gould KL, Ornish D, Kirkeeide R.  et al.  Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification.  Am J Cardiol.1992;69:845-853.Google Scholar
5.
Gould KL, Ornish D, Scherwitz L.  et al.  Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification.  JAMA.1995;274:894-901.Google Scholar
6.
Stuff JE, Garza C, Smith EO.  et al.  A comparison of dietary methods in nutritional studies.  Am J Clin Nutr.1983;37:300-306.Google Scholar
7.
Ornish D. Reversing Heart Disease. New York, NY: Ballantine Books; 1992.
8.
Billings J, Scherwitz L, Sullivan R, Ornish D. Group support therapy in the Lifestyle Heart Trial. In: Scheidt S, Allan R, eds. Heart and Mind: The Emergence of Cardiac Psychology. Washington, DC: American Psychological Association; 1996:233-253.
9.
Moyers B. Changing life habits: a conversation with Dean Ornish. In: Healing and the Mind. New York, NY: Doubleday & Co Inc; 1993.
10.
American College of Sports Medicine.  Guidelines for Exercise Testing and Prescription. Philadelphia, Pa: Lea & Febiger; 1986.
11.
SAS Institute Inc.  SAS/STAT, Version 6.08: Changes and Enhancements, SAS Technical Report P-229. Cary, NC: SAS Institute; 1992.
12.
Ornish D. More on low-fat diets.  N Engl J Med.1998;338:1623-1624.Google Scholar
13.
Brown BG, Alberts JJ, Fisher LD.  et al.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B.  N Engl J Med.1990;323:1289-1298.Google Scholar
14.
Jukema JW, Bruschke AVG, Van Boven AJ.  et al.  Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels.  Circulation.1995;91:2528-2540.Google Scholar
15.
Scandinavian Simvastatin Survival Study Group.  Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease.  Lancet.1994;344:1383-1389.Google Scholar
16.
Haskell WL, Alderman EL, Fair JM.  et al.  Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease.  Circulation.1994;89:975-990.Google Scholar
17.
Via JA, Treasure CB, Nabel EG.  et al.  Coronary vasomotor response to acetylcholine relates to risk factors for coronary artery disease.  Circulation.1990;81:491-497.Google Scholar
18.
Harrison DG, Armstrong ML, Freimann PC.  et al.  Restoration of endothelium-dependent arterial relaxation by dietary treatment of atherosclerosis.  Circulation.1987;80:1808-1811.Google Scholar
19.
Shepherd J, Cobbe SM, Ford I.  et al.  Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia.  N Engl J Med.1995;333:1301-1307.Google Scholar
20.
Hunninghake DB, Stein EA, Dujovne CA.  et al.  The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia.  N Engl J Med.1993;328:1213-1219.Google Scholar
21.
Stefanick ML, Mackey S, Sheehan M.  et al.  Effects of diet and exercise in men and postmenopausal women with low levels of HDL-C and high levels of LDL cholesterol.  N Engl J Med.1998;339:12-20.Google Scholar
22.
Katan MB, Grundy SM, Willett WC. Should a low-fat, high-carbohydrate diet be recommended for everyone? beyond low-fat diets.  N Engl J Med.1997;337:563-567.Google Scholar
23.
Lichtenstein AH, Van Horn L. Very low fat diets: AHA Science Advisory.  Circulation.1998;98:935-939.Google Scholar
24.
Brinton EA, Eisenberg S, Breslow JL. A low-fat diet decreases high density lipoprotein (HDL) cholesterol levels by decreasing HDL apolipoprotein transport rates.  J Clin Invest.1990;85:144-151.Google Scholar
25.
Connor WE, Connor SL. Should a low-fat, high-carbohydrate diet be recommended for everyone? the case for a low-fat, high-carbohydrate diet.  N Engl J Med.1997;337:562-563, 566.Google Scholar
26.
King III SB, Lembo NJ, Weintraub WS.  et al.  A randomized trial comparing coronary angioplasty with coronary bypass surgery: Emory Angioplasty versus Surgery Trial (EAST).  N Engl J Med.1994;331:1044-1050.Google Scholar
27.
Ornish D. Dietary treatment of hyperlipidemia.  J Cardiovasc Risk.1994;1:283-286.Google Scholar
28.
Morrison LM. Diet in coronary atherosclerosis.  JAMA.1960;173:884-888.Google Scholar
29.
Esselstyn Jr CB, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice.  J Fam Pract.1995;41:560-568.Google Scholar
30.
Ornish D. Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project.  Am J Cardiol.1998;82:72T-76T.Google Scholar
31.
Avorn J, Monette J, Lacour A.  et al.  Persistence of use of lipid-lowering medications.  JAMA.1998;279:1458-1462.Google Scholar
32.
Newman TB, Hulley SB. Carcinogenicity of lipid-lowering drugs.  JAMA.1996;275:55-60.Google Scholar
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Original Contribution
December 16, 1998

Intensive Lifestyle Changes for Reversal of Coronary Heart Disease

Dean Ornish, MD; Larry W. Scherwitz, PhD; James H. Billings, PhD, MPH; et al K. Lance Gould, MD; Terri A. Merritt, MS; Stephen Sparler, MA; William T. Armstrong, MD; Thomas A. Ports, MD; Richard L. Kirkeeide, PhD; Charissa Hogeboom, PhD; Richard J. Brand, PhD
Author Affiliations

From the Department of Medicine (Dr Ornish), and the Division of Cardiology (Dr Armstrong), California Pacific Medical Center, San Francisco; the Department of Medicine (Dr Ornish), the Division of Cardiology, Cardiac Catheterization Laboratory, Cardiovascular Research Institute (Dr Ports), and the Division of Biostatistics (Drs Brand and Hogeboom), School of Medicine, University of California, San Francisco; the Division of Cardiology, University of Texas Medical School, Houston (Drs Gould and Kirkeeide); and the Preventive Medicine Research Institue, Sausalito, Calif (Drs Ornish Scherwitz, and Billings, Mr Sparler, and Ms Merritt).

JAMA. 1998;280(23):2001-2007. doi:10.1001/jama.280.23.2001
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Abstract

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 percent 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.

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