Community-based comprehensive lifestyle programs in patients with coronary artery disease: Objectives, design and expected results of Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 trial (RESPONSE 2). Group office visits change dietary habits of patients with coronary artery disease-the dietary intervention and evaluation trial (D.I.E.T.). Effects of lifestyle modification on coronary artery calcium progression and prognostic factors in coronary patients--3-year results of the randomized SAFE-LIFE trial. Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol Serum cholesterol, lifestyle, working capacity and quality of life in patients with coronary artery disease. Experiences from a hospital-based secondary prevention programme. Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project. A randomized trial to evaluate the effectiveness of dietary advice by practice nurses in lowering diet-related coronary heart disease risk. Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: A randomized clinical trial Intensive lifestyle changes for reversal of coronary heart disease. Treatment of Coronary Heart Disease by Diet and Exercise Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Relationships between nutrient intake and progression/regression of coronary atherosclerosis as assessed by serial quantitative angiography. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial. Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial
UNLABELLED Patients with coronary artery disease ( CAD ) are at high risk of recurrent events . A healthy lifestyle can significantly reduce this risk . A previous trial , R and omized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists ( RESPONSE ) , demonstrated that nurse-coordinated outpatient clinics improve drug treatment of cardiovascular risk factors . However , lifestyle-related risk factors , including smoking , overweight , and physical inactivity , were common and remained largely unchanged at follow-up in most patients ( 66 % ) . The aim of the current study is to evaluate the impact of 3 community-based lifestyle programs in patients after hospitalization for CAD . We are conducting a multicenter ( n = 15 ) , r and omized trial that will recruit 800 patients to test the efficacy of up to 3 widely available commercial lifestyle programs , aim ed at patients and their partners , on top of usual care . These programs are aim ed at smoking cessation ( Luchtsignaal ( ® ) ) , weight loss ( Weight Watchers ( ® ) ) , and improving physical activity ( Philips DirectLife ( ® ) ) . OUTCOMES The primary outcome at 12months is the proportion of patients in whom at least 1 lifestyle risk factor is improved without deterioration in any of the other 2 , and a relative increase of at least 30 % in this proportion is considered clinical ly relevant BACKGROUND We evaluated the effectiveness of a low-cost group visit intervention for changing the dietary intake and lipid levels of patients with known coronary artery disease ( CAD ) . METHODS We performed a controlled r and om group assignment trial in 4 community outpatient clinics . The Dietary Intervention and Evaluation Trial r and omized 97 patients with CAD to either a control group that followed the National Cholesterol Education Program 's Step II-III diet plan ( n=48 ) or an experimental group that received meal plans , recipes , and nutritional information during monthly group office sessions ( n=49 ) . Both groups received lipid-lowering medications and were followed-up over 12 months . We assessed dietary intake , fasting lipid profiles , hemoglobin A1C levels , and per member per month ( PMPM ) expense data . RESULTS Food frequency data showed that eating fruits and vegetables and cooking with monounsaturated fat increased significantly in the experimental group compared with the control group at 1 year ( P=.0072 ; P=.0001 ; P=.0004 ) . The total PMPM expenses decreased for both groups ( 38 % for the experimental group and 10 % for the control group ) , but the cost difference was statistically nonsignificant ( P=.2975 ) . Both groups noted low-density lipoprotein reductions , significant only in the experimental group ( P=.0035 ) . CONCLUSIONS Our study suggests that using group office visits for patients with CAD was an effective method for helping subjects make dietary changes and for improving lipid levels .  Patients with known CAD and elevated lipid levels were willing to make significant lifestyle changes when offered a program that emphasizes healthy foods in a group visit format OBJECTIVE Given the multimodal medical and interventional treatment options in coronary artery disease ( CAD ) , the current value of intensified lifestyle modification remains unclear . No r and omized studies have so far assessed the impact of lifestyle modification on coronary artery calcium ( CAC ) . We examined the long-term effects of a one-year comprehensive lifestyle modification on risk factors and CAC by means of a r and omized clinical trial . METHODS 96 participants ( age range 35 - 75 years , 22 women ) of the SAFE-LIFE r and omized trial in patients with established CAD completed 3-year follow-up . The active treatment was a one-year lifestyle modification and stress reduction intervention ( LG ) , while the control group received written advice only ( AG ) .  CAC ( derived from electron beam tomography ) , blood lipids , heart rate , blood pressure , anginal symptoms and quality -of-life were assessed on entry and at 3-year follow-up . RESULTS Lifestyle modification had no impact on change of CAC after three years ( median progression factor [ 25th,75th percentile ] 1.46 [ 1.16,2.19 ] in LG and 1.41 [ 1.20,1.79 ] in AG ; p=0.68 ) , but led to reductions of blood pressure , heart rate and to dose-reductions in anti-ischemic medications as compared to AG . Multiple regression analysis indicated that in the pooled study population increase of CAC was related to psychosocial factors and heart rate . CONCLUSION In the presence of modern treatments , complementary prescription of comprehensive lifestyle modification has no impact on CAC progression but sustainable benefit for blood pressure , heart rate and the need of anti-ischemic medication is demonstrated . A possible influence of stress reduction measures on CAC progression should be further evaluated Background Coronary artery disease ( CAD ) is accountable for more than 7 million deaths each year according to the World Health Organization ( WHO ) . In a European population 80 % of patients diagnosed with CAD are overweight and 31 % are obese . Physical inactivity and overweight are major risk factors in CAD , thus central strategies in secondary prevention are increased physical activity and weight loss . Methods / Design In a r and omized controlled trial 70 participants with stable CAD , age 45–75 , body mass index 28–40 kg/m2 and no diabetes are r and omized ( 1:1 ) to 12 weeks of  intensive exercise or weight loss both succeeded by a 40-week follow-up . The exercise protocol consist of supervised aerobic interval training ( AIT ) at 85 - 90 % of VO2peak 3 times weekly for 12 weeks followed by supervised AIT twice weekly for 40 weeks . In the weight loss arm dieticians instruct the participants in a low energy diet ( 800–1000 kcal/day ) for 12 weeks , followed by 40 weeks of weight maintenance combined with supervised AIT twice weekly . The primary endpoint of the study is change in coronary flow reserve after the first 12 weeks ’ intervention . Secondary endpoints include cardiovascular , metabolic , inflammatory and anthropometric measures . Discussion The study will compare the short and long-term effects of a protocol consisting of AIT alone or a rapid weight loss followed by AIT . Additionally , it will provide new insight in mechanisms behind the benefits of exercise and weight loss . We wish to contribute to the creation of effective secondary prevention and sustainable rehabilitation strategies in the large population of overweight and obese patients diagnosed with CAD.Trial registration Clinical Trials.gov : Coronary artery diseases ( CAD ) are main causes of morbidity and hospitalisation in western countries and CAD patients are at considerable risk of suffering further cardiac events . The development and evaluation of secondary prevention programmes therefore an important task . This thesis includes investigations on CAD patients admitted to a secondary prevention programme at Malmö University Hospital , Malmö , Sweden . Four weeks after discharge from the hospital , consecutive male and female patients aged 50 - 70 years with acute myocardial infa rct ion ( AMI ) or treated with coronary artery bypass grafting ( CABG ) surgery  were r and omised to a hospital organised preventive intervention or to usual follow-up at their general practitioners . In the three studies using this r and omised design , 87 ( study II ) , 90 ( study IV ) , and 106 ( study V ) intervention patients were available for evaluation . In addition , without r and omisation , lipid levels at four weeks after the event was compared with levels estimated within 24 hours after onset of symptoms in 141 AMI patients ( study I ) , and quality of life ( QL ) were estimated by question naire at one month and at one year after the event in 266 AMI , 94 CABG , and 16 percutaneous transluminal coronary angioplasty ( PTCA ) patients ( study III ) . The prevention programme was effective in improving food habits but showed no impact on smoking habits or physical exercise in AMI patients ( study II ) . The intervention also did not show any significant improvement in working capacity in AMI and CABG patients . However , working capacity improved in both intervention and reference CABG patients , most probably due to improved coronary circulation from the surgery ( study IV ) . Cholesterol levels decreased significantly in AMI and CABG intervention patients as compared to the corresponding reference patients . This difference most likely was due to a higher frequency of lipid lowering drugs used in the intervention patients ( study V ) . The prevention programme also decreased body mass index significantly in AMI but not in CABG patients ( study V ) . In AMI patients receiving thrombolysis , cholesterol levels estimated within 24 hours after onset of symptoms and at four weeks after the event were virtually equal . In AMI patients not receiving thrombolysis , the lipid estimates from four weeks after the event were slightly , but significantly , above the within 24 hours from onset of symptoms estimates ( study I ) . One month after the event , both somatic and psychological aspects of QL were negatively affected in AMI and CABG patients compared to population controls . One year after the event , patients differed from controls mainly in somatic symptoms ( study III ) . Thus , the intervention programme was most successful in affecting lipid levels and food habits in AMI patients .  QL was considerably affected in patients following an cardiac event , especially during the initial recovery phase . In addition , in patients receiving thrombolysis , cholesterol levels estimated four weeks after an AMI are reasonably valid estimates of baseline values and may be used to decide about lipid lowering interventions OBJECTIVES The authors examined clinical outcomes in 71 male and female patients with coronary atherosclerosis who enrolled in a 2-year , independent-living , lifestyle modification program . The findings in 43 patients who completed the program were compared with those in 28 patients who dropped out of the program . BACKGROUND Clinical studies suggest that lifestyle modification of risk factors for coronary atherosclerosis reduces subsequent cardiac events but there are very few reports of the effect of these programs in patients living independently . METHODS Patients with diagnosed coronary atherosclerosis were managed for a 2-year period in a structured multidisciplinary program by a team that included two cardiologists , a nurse , a dietitian , an exercise physiologist , and a clinical psychologist . The overall aim of the program was to normalize or control all major reversible cardiovascular risk factors . Patients were required to participate in several weekly sessions for exercise , meditation/stress reduction training , dietary education and counseling , and participatory dinners . There was a strong emphasis on patient 's self care , inclusion of support members , and regular monitoring of and feedback to patients . RESULTS Data comparing baseline and 2-year outcomes showed a significant reduction in body weight , dietary intake of total/saturated fat and cholesterol , serum low- and high-density lipoprotein concentration , and an increase in exercise capacity . In the compliant group , the incidence of cardiac events was 2.3 % over 2 years . CONCLUSION Multidisciplinary lifestyle modification programs addressing cardiovascular risk factors are known to have a significant impact upon cardiac risk factors in patients with coronary atherosclerosis . Data show that these changes can be accomplished in independent-living patients in a program offered through a routine cardiology service . However , compliance is an important issue in these self-regulated programs Background Lifestyle measures of coronary heart disease ( CHD ) prevention have been overshadowed by the efficacy of drug treatments . This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering , anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials . Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects . Objectives The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years . In addition , an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study . Design A total of 197 patients with proven coronary heart disease were included and r and omised to a lifestyle intervention programme or to usual care . Follow-up was after a period of two years . Methods Intervention comprised a low fat diet , regular exercise , smoking cessation , psychosocial support and education , delivered by nurses on the rationale for pharmacological and lifestyle measures . Usual care comprised follow-up in the routine outpatient clinic . Both groups were given the same comprehensive medication according to recent guidelines . Results Patients in the lifestyle intervention group reduced the intake of saturated fat , sugar and cholesterol ( P<0.001 ) , increased their exercise level ( P<0.01 ) and stopped smoking ( P<0.05 ) when compared with the usual care group . A sub analysis of the influence of five-year CHD calculated risk in males result ed in a relative risk reduction of 22 % ( 95 % confidence intervals 9 - 35 ) . Although significant , this result must be interpreted with caution due to poor statistical power and reproducibility of the method . Conclusions In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet , exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males 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 , aim ed at improving diet ( low fat , whole foods , plant-based ) , exercise , stress management , and social support . Spousal participation was encouraged . Both genders evidence d significant improvements in their diet , exercise , and stress management practice s , 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 BACKGROUND Dietary factors are an important contribution to the high rates of coronary heart disease in the UK . One approach to achieving change is health-promoting advice in primary care . AIM To compare the effectiveness of structured dietary advice by practice nurses with st and ard health education in changing serum cholesterol , weight and diet . METHOD R and omized , controlled trial within eight general practice s in Engl and and Wales allocated within matched geographical pairs to ' dietary advice ' or ' usual care ' .  Men and women aged 35 - 59 years , recruited opportunistically by their GPs , underwent health checks . In ' dietary advice ' practice s , subjects received dietary advice from specially trained nurses based on negotiated change principles , reinforced at follow up . In ' usual care ' practice s , subjects were only given st and ard health education material s. RESULTS A total of 956 patients were recruited : 473 in ' dietary advice ' practice s and 483 in ' usual care ' practice s. Compliance with annual follow up was 80 % . Compared with ' usual care ' practice s , there was a mean 0.20 mmol/l lower serum cholesterol ( 95 % CI -0.38 to -0.03 at 1 year ) in ' dietary advice ' practice s. There was a small fall in weight of 0.56 kg ( 95 % CI -1.04 to -0.07 ) and reductions in total and saturated fat . Factor VII coagulant activity fell by a mean of 6.7 % of the st and ard ( 95 % CI -15.4 to + 2.0 ) . CONCLUSION Provision of st and ard health education material alone as part of a health check had no effect on coronary heart disease risk factors . There were modest changes in diet and associated risk factors when a more intensive and individual approach to dietary advice was given by practice nurses . This is , however , probably an ineffective use of re sources , except in those at high risk of coronary heart disease . Whole- population strategies to achieve dietary change are required Background : Nurse-led interventions have proven beneficial to reduce estimated cardiovascular risk . Aim : The purpose of this study was to evaluate the effect of systematic , nurse-led individual lifestyle counseling sessions on the reduction of 10-year cardiovascular risk scores in patients with coronary artery disease ( CAD ) . Methods : This was a r and omized clinical trial of CAD patients treated at a tertiary referral hospital . The intervention group received nurse-led guidance by means of five face-to-face sessions and telephone contact over the course of one year , starting three months after hospital discharge . Exercise and dietary goals were set for each patient and monitored at each session . The control group received st and ard medical advice . Patients were stratified by Framingham risk score and compared at the end of the follow-up period . Results : The final sample comprised 74 patients , 38 in the intervention group and 36 in the control group . Mean age was 58±9 years ; 74 % of patients were male . A 1.7 point ( −13.6 % ) reduction in risk score was recorded in the intervention group , vs a 1.2 point increase in risk score ( + 11 % ) in the control group ( p=0.011 ) . Significant between-group differences were detected for weight ( intervention , 78±14 kg at baseline vs 77±14 kg at study end ; control , 78±15 kg vs 79±15 kg ; p=0.04 ) , systolic blood pressure ( intervention , 136±22 mm Hg vs 124±15 mm Hg ; control , 126±15 mm Hg vs 129±16 mm Hg ; p=0.005 ) , and diastolic blood pressure ( intervention , 82±10 mm Hg vs 77±09 mm Hg ; control , 79±09 mm Hg vs 80±10 mm Hg ; p=0.02 ) . Conclusion : Structured and systematic nurse-led lifestyle counseling effectively reduced cardiovascular risk score 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 R and omized controlled trial conducted from 1986 to 1992 using a r and omized invitational design . PATIENTS Forty-eight patients with moderate to severe coronary heart disease were r and omized 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 Management of risk factors by diet and exercise in patients with coronary heart disease in two controlled studies , result ed in significant modification of atherogenic lipoproteins , myocardial perfusion , and physical work capacity . Moreover , within 1 year there were significantly more regression and less progression of coronary atherosclerosis in the study group compared to usual care control patients . Follow-up for 6 years showed erosion of dietary discipline , unfavorable changes in li-poprotein levels , and subsequent progression of coronary lesions in many patients . It is concluded that the course of coronary heart disease can be favorably modified by intensive dietary counseling and supervised exercise , but that maintenance of positive results remain a challenge for physicians and patients alike BACKGROUND Treatment of coronary artery disease ( CAD ) is evolving with better medications , improvements in percutaneous coronary intervention ( PCI ) , and enhanced techniques for coronary artery bypass grafting ( CABG ) . METHODS In this study , 18,481 patients with significant ( > 75 % stenosis ) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy : medical therapy ( MED ) ( n = 6862 ) , PCI ( n = 6292 ) , or CABG ( n = 5327 ) . Each group was categorized into 3 groups according to baseline severity of CAD : low-severity ( predominantly 1-vessel ) , intermediate-severity ( predominantly 2-vessel ) , and high-severity ( all 3-vessel ) , and prospect ively evaluated in Cox models for all-cause mortality adjusted for cardiac risk , comorbidity , and propensity for selection of a specific treatment . Treatments were compared for the entire period and three eras ( 1 : 1986 to 1990 ; 2 : 1991 to 1995 ; 3 : 1996 to 2000 ) , the last encompassing widespread availability of PCI with stenting . RESULTS Survival significantly improved in all groups for all degrees of CAD , despite increasing severity of illness . Revascularization strategies provided significant survival over MED with 8.1 , 10.6 , and 23.6 additional months per 15 years of follow-up for low-severity , intermediate-severity , and high-severity CAD , respectively . Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up ( 95 % confidence interval , 0.2 to 10.2 ; p = 0.039 ) in era 3 for CABG compared with PCI for high-severity CAD . CONCLUSIONS Initial revascularization strategies result in significant survival advantage over MED for all CAD levels . Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG To eluci date the direction and magnitude of effects of nutrition on coronary artery disease ( CAD ) , the relation between nutrient intake and angiographic changes were examined in the course of a controlled dietary trial . Ninety men with symptomatic CAD and serum cholesterol greater than 232 mg/dL were entered into a r and omized controlled trial of a lipid-lowering diet , or of diet plus cholestyramine , compared with usual cardiac care . Of those in the first and second groups , 50 patients completed the trial and are the subject of this report . Quantitative coronary angiography was performed at baseline and at 39 months . From repeated dietary assessment during the trial , mean nutrient intakes were computed , and their relationships with change of coronary artery narrowing were analyzed . Progression of coronary disease was directly , strongly and independently associated with intake of saturated fatty acids of chain length 14 - 18 . This was not fully explained by the effects of saturated fat in raising serum cholesterol ; after adjustment for low density lipoprotein cholesterol level , stearic acid ( C18:0 ) intake remained independently predictive of progression . No ' protective ' effect of linoleic , linolenic or eicosapentaenoic acid was demonstrable . Intake of trans fatty acids was directly related to progression . Together with the favourable treatment effects on angiographic appearance and clinical end-points , these findings provide further support for a causal role of saturated fats in CAD ; restriction of foods containing such fats should be emphasized as part of regimens aim ed to reduce progression of coronary atherosclerosis BACKGROUND The rapid emergence of coronary artery disease ( CAD ) in south Asian people is not explained by conventional risk factors . In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid , we assessed the benefits of this diet for patients at high risk of CAD . METHODS We did a r and omised , single-blind trial in 1000 patients with angina pectoris , myocardial infa rct ion , or surrogate risk factors for CAD . 499 patients were allocated to a diet rich in whole grains , fruits , vegetables , walnuts , and almonds . 501 controls consumed a local diet similar to the step I National Cholesterol Education Program ( NCEP ) prudent diet . FINDINGS The intervention group consumed more  fruits , vegetables , legumes , walnuts , and almonds  than did controls ( 573 g [ SD 127 ] vs 231 g [ 19 ] per day p<0.001 ) . The intervention group had an increased intake of whole grains and mustard or soy bean oil . The mean intake of alpha-linolenic acid was two-fold greater in the intervention group ( 1.8 g [ SD 0.4 ] vs 0.8 g [ 0.2 ] per day , p<0.001 ) . Total cardiac end points were significantly fewer in the intervention group than the controls ( 39 vs 76 events , p<0.001 ) . Sudden cardiac deaths were also reduced ( 6 vs 16 , p=0.015 ) , as were non-fatal myocardial infa rct ions ( 21 vs 43 , p<0.001 ) . We noted a significant reduction in serum cholesterol concentration and other risk factors in both groups , but especially in the intervention diet group . In the treatment group , patients with pre-existing CAD had significantly greater benefits compared with such patients in the control group . INTERPRETATION An Indo-Mediterranean diet that is rich in alpha-linolenic acid might be more effective in primary and secondary prevention of CAD than the conventional step I NCEP prudent diet AIMS AND OBJECTIVES To evaluate the one-year prognosis of a lifestyle counselling intervention ( diet , smoking cessation and exercise ) among patients who had open heart surgery . BACKGROUND Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries . Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease . DESIGN R and omised , nonblind and lifestyle counselling intervention study with a one-year follow-up . METHODS A r and omised , nonblind intervention study was performed on 500 patients who had open heart surgery . After hospital discharge , 250 patients ( intervention group ) were r and omly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology ( European Journal Preventive Cardiology , 19 , 2012 , 585 ) . The remaining 250 patients ( control group ) received the regular instructions . Primary end-point was the development of a cardiovascular disease ( nonfatal event ) during the first year ; secondary end-points included fatal events , smoking abstinence , dietary habits and a physical activity evaluation . RESULTS According to the primary end-point , the odds of having a nonfatal cardiovascular disease event are 0·56-times ( 95%CI 0·28 , 0·96 , p = 0·03 ) lower for the intervention group compared to the control group . One-year after surgery , it was found that participants in the intervention group were 1·96-times ( 95%CI 1·31 , 2·93 , p < 0·001 ) more likely to achieve dietary recommendations , 3·32-times ( 95%CI 2·24 , 4·91 , p < 0·001 ) more likely to achieve physical activity recommendations and 1·34-times ( 95%CI 1·15 , 1·56 , p < 0·001 ) more likely to return to work . CONCLUSION Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event . Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient 's needs . RELEVANCE TO CLINICAL PRACTICE A well-structured cardiac rehabilitation programme adjusted to the patient 's profile is a safe and cost-effective way to improve patients ' outcome OBJECTIVE To evaluate the effectiveness of a nurse led shared care programme to improve coronary heart disease risk factor levels and general health status and to reduce anxiety and depression in patients awaiting coronary artery bypass grafting ( CABG ) . DESIGN R and omised controlled trial . SETTING Community , January 1997 to March 1998 . STUDY GROUPS 98 ( 75 male ) consecutive patients were recruited to the study within one month of joining the waiting list for elective CABG at Glasgow Royal Infirmary University NHS Trust . Patients were r and omly assigned to  usual care ( control ; n = 49 ) or a  nurse led intervention programme  ( n = 49 ) . INTERVENTION A shared care programme consisting of health education and motivational interviews , according to individual need , was carried out monthly . Care was provided in the patients ' own homes by the community based cardiac liaison nurse alternating with the general practice nurse at the practice clinic . OUTCOME MEASURES Smoking status , obesity , physical activity , anxiety and depression , general health status , and proportion of patients exceeding target values for blood pressure , plasma cholesterol , and alcohol intake . RESULTS Compared with patients who received usual care , those participating in the nurse led programme were more likely to stop smoking ( 25 % v 2 % , p = 0.001 ) and to reduce obesity ( body mass index > 30 kg/m2 ) ( 16.3 % v 8.1 % , p = 0.01 ) . Target systolic blood pressure improved by 19.8 % compared with a 10.7 % decrease in the control group ( p = 0.001 ) and target diastolic blood pressure improved by 21.5 % compared with 10.2 % in the control group ( p = 0.000 ) . However , there was no significant difference between groups in the proportion of patients with cholesterol concentrations exceeding target values . There was a significant improvement in general health status scores across all eight domains of the 36 item short form health survey with changes in difference in mean scores between the groups ranging from 8.1 ( p = 0.005 ) to 36.1 ( p < 0.000 ) . Levels of anxiety and depression improved ( p < 0.000 ) and there was improvement in time spent being physically active ( p < 0.000 ) . CONCLUSIONS This nurse led shared care intervention was shown to be effective for improving care for patients on the waiting list for CABG
Available studies show convincingly the health benefits of lifestyle changes in CAD patients .
Effect estimates of combined dietary changes look promising .
BACKGROUND Guidelines for lifestyle and dietary modification in patients with coronary artery disease ( CAD ) are mainly supported by evidence from general population studies .
CAD patients , however , differ from the general population in age ( older ) and treatment with preventive drugs .
This review seeks to provide evidence for a prognostic benefit of lifestyle and dietary recommendations from studies in CAD patients .