The role of comprehensive lifestyle changes in the prevention and treatment of coronary heart disease

II Abstract Chronic non-communicable diseases including coronary heart disease and type 2 diabetes have become a worldwide epidemic. As of 2002, type 2 diabetes is considered a risk equivalent to coronary heart disease (CHD) in most persons with type 2 diabetes. Both diseases share the same underlying risk factors. In the INTERHEART Study, 9 risk factors have been identified that are relevant in the etiology and prognosis of CHD, accounting for 90% of CHD risk in men and 94% in women. These risk factors are medical as well as psychological in nature and are potentially modifiable by lifestyle changes. The aim of this dissertation was to investigate the role of comprehensive lifestyle changes in the prevention and treatment of CHD. Findings of this dissertation were based on 1 completed randomized phase III trial (i.e., Lifestyle Heart Trial; LHT; n=48) and 2 health-insurance sponsored multi-site demonstration projects (phase IV; the completed Multicenter Lifestyle Demonstration Project, MLDP, n=440; the ongoing Multisite Cardiac Lifestyle Intervention Program, MCLIP, n>2000). The comprehensive lifestyle intervention that was evaluated in these stage III and IV trials consisted of a low-fat, plant-based diet, exercise, stress management, and group support sessions. Follow-ups ranged from 3 months to 5 years. The following questions were addressed in this dissertation: 1. ) Can comprehensive lifestyle changes improve psychological well-being in patients with CHD for up to 5 years and are these changes associated with changes in cardiac variables and well-being in the LHT? 2. ) Can patients with CHD and type 2 diabetes in the MLDP make comprehensive lifestyle changes experiencing similar improvements in coronary risk factors and quality of life when compared to CHD patients without type 2 diabetes over 1 year? 3. ) Can CHD patients at risk for heart failure with a left ventricular ejection fraction (LVEF) ≤ 40% (stage B according to the guidelines of the American College of Cardiology/American Heart Association) in the MLDP make comprehensive lifestyle changes to achieve a similar improvement in medical risk factors and quality of life as those with a LVEF >40% over 1 year? 4. ) Is attendance to the intervention’s social support groups in the MLDP associated with CHD patients’ adherence to the other 3 program components and with improvements in coronary risk factors and quality of life over 1 year? 5. ) Can depressed patients at high risk for CHD (i.e., ≥3 coronary risk factors and/or type 2 diabetes) in theChronic non-communicable diseases including coronary heart disease and type 2 diabetes have become a worldwide epidemic. As of 2002, type 2 diabetes is considered a risk equivalent to coronary heart disease (CHD) in most persons with type 2 diabetes. Both diseases share the same underlying risk factors. In the INTERHEART Study, 9 risk factors have been identified that are relevant in the etiology and prognosis of CHD, accounting for 90% of CHD risk in men and 94% in women. These risk factors are medical as well as psychological in nature and are potentially modifiable by lifestyle changes. The aim of this dissertation was to investigate the role of comprehensive lifestyle changes in the prevention and treatment of CHD. Findings of this dissertation were based on 1 completed randomized phase III trial (i.e., Lifestyle Heart Trial; LHT; n=48) and 2 health-insurance sponsored multi-site demonstration projects (phase IV; the completed Multicenter Lifestyle Demonstration Project, MLDP, n=440; the ongoing Multisite Cardiac Lifestyle Intervention Program, MCLIP, n>2000). The comprehensive lifestyle intervention that was evaluated in these stage III and IV trials consisted of a low-fat, plant-based diet, exercise, stress management, and group support sessions. Follow-ups ranged from 3 months to 5 years. The following questions were addressed in this dissertation: 1. ) Can comprehensive lifestyle changes improve psychological well-being in patients with CHD for up to 5 years and are these changes associated with changes in cardiac variables and well-being in the LHT? 2. ) Can patients with CHD and type 2 diabetes in the MLDP make comprehensive lifestyle changes experiencing similar improvements in coronary risk factors and quality of life when compared to CHD patients without type 2 diabetes over 1 year? 3. ) Can CHD patients at risk for heart failure with a left ventricular ejection fraction (LVEF) ≤ 40% (stage B according to the guidelines of the American College of Cardiology/American Heart Association) in the MLDP make comprehensive lifestyle changes to achieve a similar improvement in medical risk factors and quality of life as those with a LVEF >40% over 1 year? 4. ) Is attendance to the intervention’s social support groups in the MLDP associated with CHD patients’ adherence to the other 3 program components and with improvements in coronary risk factors and quality of life over 1 year? 5. ) Can depressed patients at high risk for CHD (i.e., ≥3 coronary risk factors and/or type 2 diabetes) in the