|
Can lifestyle changes reverse coronary heart disease?
The Lifestyle Heart Trial. Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL. Pacific Presbyterian Medical Center, Sausalito, California. In a prospective, randomized, controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year,
28 patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise)
brand 20 to a usual-care control group. 195 coronary artery lesions were analyzed by quantitative coronary angiography. The average percentage
diameter stenosis regressed from 40.0 (SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)%
in the control group. When only lesions greater than 50% stenosed were analyzed, the average percentage diameter stenosis regressed from
61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group. Overall,
82% of experimental-group patients had an average change towards regression. Comprehensive lifestyle changes may be able to bring about
regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs. Publication Types:
• Clinical Trial
• Randomized Controlled Trial
Lancet. 1990 Jul 21;336(8708):129-33 Comment in: Lancet. 1990 Sep 8;336(8715):624-6. PMID: 1973470 [PubMed - indexed for MEDLINE] Lifestyle Changes Improve Blood Pressure Weight Loss, Exercise, Less Salt and Alcohol Go a Long Way
By Lisa Habib
WebMD Medical News Reviewed By Michael W. Smith
on Monday, September 22, 2003 May 14, 2003 -- New national blood pressure guidelines stress that a healthy lifestyle is critical to preventing and treating high blood pressure.
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure report says lifestyle changes including
weight loss, exercise, eating less salt, and drinking less alcohol can go a long way toward decreasing blood pressure, lowering heart-disease risk,
and making blood pressure drugs work better. Here's how the report says such lifestyle changes can reduce systolic blood pressure (the "top" number in a blood pressure reading). By lowering
your systolic blood pressure, your diastolic blood pressure would likely come down as well.
Lifestyle Change |
Recommendation |
Appx. Systolic BP Reduction |
| Weight loss |
Normal BMI of 18.5 - 24.9* |
5 - 20 points per 22 lbs. lost |
Follow DASH eating plan* |
Diet high in fruits, vegetables,
low-fat dairy, and low in fat |
8 -14 points |
| Salt reduction |
Limit salt to 2,400 milligrams per day |
2 - 8 points |
| Exercise |
30 minutes of physical activity
most days of the week |
4 - 9 points |
| Moderate drinking |
Limit alcohol to no more
than two drinks per day |
2 - 4 points |
*BMI is body mass index, a measurement of the ratio of height to weight. It can be calculated by dividing your weight (in kilograms) by your height
(in meters, squared). Or it can be calculated by multiplying weight (in pounds) by 705, then dividing by height (in inches) twice. **The report recommends people with high blood pressure follow the DASH diet -- Dietary Approaches to Stop Hypertension. This eating plan is based
on a daily intake of 2,000 calories: • 7-8 servings per day of grains and grain products (these can include breakfast cereal, whole grain bread, rice, pasta, etc.)
• 4-5 servings of vegetables
• 4-5 servings of fruit
• 2-3 servings of low-fat or nonfat dairy foods
• No more than two servings per day of meat, poultry, and fish
• 4-5 servings of nuts, seeds, and legumes per week
• 2-3 servings of fats and oils (serving example: 1 teaspoon of margarine or oil, 1 tablespoon of salad dressing or mayonnaise)
• 5 servings of sweets per week (only low-fat treats like sugar, jelly, or sorbet) SOURCES: The Journal of the American Medical Association, May 21, 2003. WebMD Medical Reference in collaboration with The Cleveland Clinic, "Body Mass Index."
National Heart, Lung, and Blood Institute, Lifestyle Changes Better Than Drugs for Diabetes Men and women at high risk of developing type 2 diabetes can reduce this risk by losing weight and exercising, study findings show. The diabetes drug
Glucophage can also cut diabetes risk if given preemptively, but not as dramatically. About 8% of US adults have type 2 diabetes, in which the body loses the ability to respond properly to the blood sugar-regulating hormone insulin.
There are well-known risk factors for the disease, including high blood sugar levels after fasting, being overweight, and living a sedentary lifestyle. To determine whether targeting lifestyle factors with weight loss and exercise, or giving at-risk patients Glucophage, which helps the body respond
better to insulin, would cut diabetes risk, the researchers compared these two approaches with an inactive placebo in more than 3,200 nondiabetic men and women. The average age of study participants was 51, and all had high blood glucose levels. Their average body mass index (BMI) was 34. BMI is a measure of weight in
relation to height, and a person with a BMI of 30 or higher is considered obese. Study participants were randomly assigned to a placebo, 850 milligrams of Glucophage twice daily, or a lifestyle change program intended to help them lose
at least 7% of their weight and engage in 150 minutes of physical activity per week. During the follow-up period, which lasted nearly 3 years, the investigators found that patients in the lifestyle intervention group saw the greatest reduction in their
diabetes risk. They had a 58% lower risk of developing type 2 diabetes than people in the placebo group. Those given Glucophage cut their diabetes risk by 31%. The lifestyle program was significantly more effective than Glucophage therapy in all age groups. This study shows that type 2 diabetes is not inevitable. It is not necessary to wait until a person has type 2 diabetes to begin doing something about it. The New England Journal of Medicine February 7, 2002;346:393-403
|
