Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project

doi:10.1016/S0002-9149(03)00320-5

The American Journal of Cardiology

Volume 91, Issue 11, 1 June 2003, Pages 1316-1322

https://doi.org/10.1016/S0002-9149(03)00320-5 Get rights and content

Abstract

This study examined medical and psychosocial characteristics of 440 patients (mean age 58 years, 21% women) with coronary artery disease at baseline and at 3-month and 12-month follow-ups. All patients were participants in the Multicenter Lifestyle Demonstration Project, aimed at improving diet (low fat, whole foods, plant-based), exercise, stress management, and social support. Spousal participation was encouraged. Both genders evidenced significant improvements in their diet, exercise, and stress management practices, which they maintained over the course of the study. Both women and men also showed significant medical (e.g., plasma lipids, blood pressure, body weight, exercise capacity) and psychosocial (e.g., quality of life) improvement. Despite their worse medical, psychosocial, and sociodemographic status at baseline, women’s improvement was similar to that of men’s. These results demonstrate that a multi-component lifestyle change program focusing on diet, exercise, stress management, and social support can be successfully implemented at hospitals in diverse regions of the United States. Furthermore, this program may be particularly beneficial for women with coronary artery disease who generally have higher mortality and morbidity than men after a heart attack, angioplasty, or bypass surgery.

Section snippets

Recruitment and procedure

Hospital site selection was based on location in geographically diverse areas with sufficient population density (>500,000 people within a 60-minute drive time of the site); a sizeable cardiology program; the demonstration of interest and support from key physicians; and the ability to convince large health insurance providers of the value of including the program in their benefit plan. Accordingly, MLDP teams were trained at 8 sites: Omaha, Nebraska; New York, New York; Des Moines, Iowa; Ft.

Baseline characteristics

Demographic characteristics, medical history, and medications of the 440 patients (79% men) are listed in Table 1. One hundred ninety-four patients (44% of all men and 43% of all women) were approved for a revascularization procedure (Group 1) and 246 (56% of all men and 57% of all women) had a previous revascularization procedure and were in stable condition (Group 2). There was no significant difference in age between men and women. On average, women were socially more disadvantaged than men,

Discussion

The results of this study indicate that this program of comprehensive lifestyle changes can be successfully implemented at hospitals across the country. By the end of 1 year, participants of both the LHT2 and the MLDP reported similar levels of dietary fat intake (LHT, 6.8% of total calories from fat; MLDP, 6.3% for men, 7.6% for women). However, MLDP participants spent fewer hours per week exercising (men 3.7; women 3.0) and practicing stress management (men 4.8; women 4.5) than LHT patients

Acknowledgments

Special appreciation is expressed to Vance Smith, MPH, and Mutual of Omaha. We also like to thank Staffan Avne, MD, for his helpful comments on an earlier version of this manuscript and Megan Campbell, BS, and Jessica Williams, BS, for their invaluable assistance. This study is based, in part, on the primary investigator’s (JK) doctoral thesis submitted to the Karolinska Institute (Stockholm, Sweden) and was completed with the guidance of the corresponding author (GW).

References (30)

W. Linden
Psychological treatments in cardiac rehabilitationreview of rationales and outcomes
J Psychosom Res
(2000)
D. Ornish et al.
Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial
Lancet
(1990)
A. Antonovsky
The structure and properties of the sense of coherence scale
Soc Sci Med
(1993)
S. Folkman
Positive psychological states and coping with severe stress
Soc Sci Med
(1997)
L.B. Cannistra et al.
Comparison of the clinical profile and outcome of women and men in cardiac rehabilitation
Am J Cardiol
(1992)
C.J. Lavie et al.
Benefits of cardiac rehabilitation and exercise training in elderly women
Am J Cardiol
(1997)
V. Brezinka et al.
Psychosocial factors of coronary heart disease in womena review
Soc Sci Med
(1996)
D. Ornish et al.
Intensive lifestyle changes for reversal of coronary heart disease. Five-year follow-up of the Lifestyle Heart Trial
JAMA
(1998)
K.L. Gould et al.
Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification
JAMA
(1995)
D. Ornish
Avoiding revascularization with lifestyle changesthe Multicenter Lifestyle Demonstration Project
Am J Cardiol
(1998)

D. Perloff et al.

Human blood pressure determination by sphygmomanometry

Circulation

(1993)

G.A. Rose et al.

Cardiovascular Survey Methods

(1982)

E.B. Rimm et al.

Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals

Am J Epidemiol

(1992)

J.J. Ware et al.

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection

Med Care

(1992)

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Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project

Abstract

Section snippets

Recruitment and procedure

Baseline characteristics

Discussion

Acknowledgments

J Psychosom Res

Lancet

Soc Sci Med

Soc Sci Med

Am J Cardiol

Am J Cardiol

Soc Sci Med

Intensive lifestyle changes for reversal of coronary heart disease. Five-year follow-up of the Lifestyle Heart Trial

JAMA

Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification

JAMA

Avoiding revascularization with lifestyle changesthe Multicenter Lifestyle Demonstration Project

Am J Cardiol

Human blood pressure determination by sphygmomanometry

Circulation

Cardiovascular Survey Methods

Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals

Am J Epidemiol

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection

Med Care