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APHA Scientific Session and Event Listing

Recorded presentation

William B. Stason, MD, MSci, Donald S. Shepard, PhD, Stephen Fournier, PhD, Grant Ritter, PhD, Jose Suaya, and Gail K. Strickler, MS, MA. Schneider Institute for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454, 781 736 3957, wbstason@comcast.net

The Medicare Lifestyle Modification Program Demonstration is evaluating the benefits of two national programs in patients with advanced, but stable, coronary heart disease: The Dr. Dean Ornish Program for Reversing Heart Disease and the Mind/Body Medical Institute's Cardiac Wellness Program directed by Dr. Herbert Benson. Both programs use intense multifactor interventions for 3 months, followed by 9 months of less intense interventions, and follow-up for a total of 24 months. By the end of 2005, 528 patients had enrolled: 139 in Dr. Ornish's program and 389 in Dr. Benson's program. Based on data from the first 443 enrollees, at baseline, 76% of patients were receiving lipid-lowering medications; the mean total cholesterol was 163 mg/dl; mean low-density lipoprotein (LDL) cholesterol was 91 mg/dl; and the mean body mass index (BMI) was 28.6. Favorable changes in total cholesterol and LDL were statistically significant at 3 and 12 months, but not at 24 months. Decreases in BMI were significant at all three intervals. Measures of psychological function improved significantly in each program at 3 and 12 months and remained favorable, but not significant, at 24 months. These improvements may reflect the high degree of motivation of participants enrolled in these programs as well as program impacts. Overall, the two programs achieved comparable results. However, results favored The Dr. Dean Ornish Program for weight loss and reductions in total cholesterol and favored the Mind/Body Medical Institute's program for changes in blood pressure and high-density lipoprotein (HDL) cholesterol. Advantages of the former program may be due to the greater emphasis placed on achieving a very low fat diet (target of 10% or less calories from fat) or the greater intensity of the program; while advantages of the latter program may reflect the greater emphasis placed on the relaxation response and more lenient goals for dietary fat that may protect levels of “good” HDL cholesterol. The presentation will include the latest available data from both lifestyle modification programs.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

• Describe the interventions included in each of these national lifestyle modification programs.
• Identify the changes in cardiovascular risk factors achieved initially and their persistence over time.
• Assess the importance of patient motivation in achieving longlasting lifestyle modifications.

Keywords: Heart Disease, Health Behavior

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation