CORONARY DISEASE REVERSAL

CAD and proof of arrest and reversal 3.

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One and five years later.
195 coronary artery lesions were analysed by quantitative coronary angiography.
One year later.  
 
Control group:
20 subjected to usual-care.
One year and  5 year.
Life style changed group:
28 patients were treated by low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise.
No lipid-lowering drugs was used.
One year.
-------
5 year
Effect on stenosis
Progressed from 427 (155)% to 461 (185)%.
 
 One year:
The average percentage diameter stenosis regressed from 400 (SD 169)% to 378 (165)%.
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5 years:
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).
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When only lesions greater than 50% stenosis were analysed:
.
One year:Progressed from 617 (95)% to 644 (163)%.
--------------
5 Year:
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.
 
 
The average percentage diameter stenosis regressed from 611 (88)% to 558 (110)%.
 

Over all changes.

x

Overall, 82% of patients had an average change towards regression.

Cardiac events during the 5-year follow-up.
 
 

 45 events in 20 control group patients (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]).
 

Twenty-five cardiac events occurred in 28 experimental group patients.
 
 
 

 5-year follow-up completion.

15 [75%] of 20 patients completed 5-year follow-up and made more moderate changes.

20 [71%] of 28 patients completed 5-year follow-up and maintained comprehensive lifestyle changes for 5 years.
 
 
 

Comment.

Coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.
"Patients in the control group who were not prescribed lipid-lowering drugs during the study showed more than 3 times as much progression in percent diameter stenosis as those who were.."
"4 lesions were lost in the control group to bypass surgery or angioplasty; since these lesions were worsening sufficiently to require revascularization, the exclusion of these lesions from analysis would make between-group differences more difficult to detect.."

More regression of coronary atherosclerosis occurred after 5 years than after 1 year.
"We do not know if experimental group patients may have demonstrated even more improvement by including lipid-lowering drugs."
Higher to the adherence to life style changes, better was the improvement of stenosis.

 

Figure

Figure 2.—Changes in percentage diameter stenosis by 5-year adherence tertiles for the experimental group.

 

D. Ornish. Can lifestyle changes reverse coronary heart disease?The Lancet, Volume 336, Issue 8708, Pages 129 - 133, 21 July 1990

Dean Ornish. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998;280(23):2001-2007.

  1. 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.

 
 
 
 
 
CAD AND PROOF OF ARREST AND REVERSAL 3
 
 
 
 
 
 
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From Dr. Dean Ornish's book: The Spectrum. 2007. Page 10-11
 
In 1986, there were two basic ways to evaluate CAD severity,
1. Anatomical or structural: Coronary angiogram shows the severity of blockage of the artery.
2. Phyiological or functional: Measure of blood flow to the heart by PET (Positron Emmission Tomography) scans.
 
An example:
 
The subject enter the study in 1986 at age 64 with history of severe angina, and unable to walk more than a few steps without severe chest pain.
He had severe CAD involving all major coronary arteries and advised coronary bypass surgery.
After six weeks of intensive diet therapy, he was pain free.
After a year, he was able to climb 130 floors per day on a StairMaster with no angina. 
PET scan showed 300 percent improvement in blood flow to his heart.
Angiogram revealed reversal of coronary atherosclerosis. He also lost 39 pounds.
 
The picture in the upper-left-hand corner: The "before" picture of his angiogram, showing significant narrowing in the coronary artery.
The upper-right-hand photo: One year later that area is significantly wider.
The PET scans:
The bottom two pictures:
The darker areas are receiving very little blood flow to the heart.
The brighter areas are receiving the most blood flow.
The picture at the lower left:
His heart was not receiving adequate blood flow, as shown by the large dark areas.
The lower right-hand-picture: One year later, the most of the darker areas are replaced by brighter ones, showing substantially more blood flow.
 
  1. K. Lance Gould, Dean Ornish,et al. Positron Emission Tomography After Long-term, Intense Risk Factor Modification. 1995;274(11):894-901. doi: 10.1001/jama.1995.03530110056036

http://jama.ama-assn.org/content/274/11/894.abstract

 

 
 
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Figure
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Figure 2.—Changes in percentage diameter stenosis by 5-year adherence  for the experimental group.

 
 

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