0
January 7, 1983, Vol 249, No. 1 >
ARTICLE | January 7, 1983

Effects of Stress Management Training and Dietary Changes in Treating Ischemic Heart Disease FREE

Dean Ornish, MD; Larry W. Scherwitz, PhD; Rachelle S. Doody; Deborah Kesten, MPH; Sandra M. McLanahan, MD; Shirley E. Brown, MD; E. Gordon DePuey, MD; Robert Sonnemaker, MD; Cathie Haynes, RN; Jerry Lester, PhD; Gay K. McAllister, RN; Robert J. Hall, MD; John A. Burdine, MD; Antonio M. Gotto, Jr, MD, DPhil
[+] Author Affiliations

Read in part before the annual scientific meeting of the American College of Cardiology, Atlanta, April 25-29, 1982.

Reprint requests to Medical Resident, Massachusetts General Hospital, Boston, MA 02114 (Dr Ornish).


JAMA. 1983;249(1):54-59. doi:10.1001/jama.1983.03330250034024
Text Size: A A A
Published online
Article
References

To evaluate the short-term effects of an intervention that consists of stress management training and dietary changes in patients with ischemic heart disease (IHD), we compared the cardiovascular status of 23 patients who received this intervention with a randomized control group of 23 patients who did not. After 24 days, patients in the experimental group demonstrated a 44% mean increase in duration of exercise, a 55% mean increase in total work performed, somewhat improved left ventricular regional wall motion during peak exercise, and a net change in the left ventricular ejection fraction from rest to maximum exercise of +6.4%. Also, we measured a 20.5% mean decrease in plasma cholesterol levels and a 91.0% mean reduction in frequency of anginal episodes. In this selected sample, short-term improvements in cardiovascular status seem to result from these adjuncts to conventional treatments of IHD.

(JAMA 1983;249:54-59)

REFERENCES

1 +
Harvey W, cited by Eastwood MR,  Trevelyan H: Stress and coronary heart disease . J Psychosom Res 1971;;15:289-292.
2 +
Hackett TP, Rosenbaum JF:  Emotion, psychiatric disorders, and the heart , in Braunwald E (ed): Heart Disease . Philadelphia, WB Saunders Co, 1980;, pp 1923-1943.
3 +
Benson H:  Systemic hypertension and the relaxation response . N Engl J Med 1977;; 296:1152-1156.
4 +
Patel CH:  Reduction of serum cholesterol and blood pressure in hypertensive patients by behavior modification . J R Coll Gen Pract 1976;; 26:211-215.
5 +
Cooper MJ, Aygen MM:  A relaxation technique in the management of hypercholesterolemia . J Human Stress 1979;;4:24-27.
6 +
Shekelle RB, Shyrock AM, Paul O, et al:  Diet, serum cholesterol, and death from coronary heart disease: The Western Electric Study . N Engl J Med 1981;;304:65-70.
7 +
Sacks FM, Castelli WP, Donner A, et al:  Plasma lipids and lipoproteins in vegetarians and controls . N Engl J Med 1975;;292:1148-1151.
8 +
Sacks FM, Rosner B, Kass EH:  Blood pressure in vegetarians . Am J Epidemiol 1974;; 100:390-398.
9 +
Ellis FR, Sanders T:  Angina and vegan diet . Am Heart J 1977;;93:803-805.
10 +
Okada RD, Boucher CA, Strauss HW, et al:  Exercise radionuclide imaging approaches to coronary artery disease . Am J Cardiol 1980;; 46:1188-1204.
11 +
Goldstein A: Biostatistics . New York, Macmillan Publishing Co Inc, 1964;, pp 6-8.
12 +
Borer JS, Bacharach SL, Green MV, et al:  Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease . N Engl J Med 1977;;296:839-844.
13 +
Manual of Laboratory Operations, Lipid Research Clinics Program, vol 1, in Lipid and Lipoprotein Analysis, US Dept of Health, Education, and Welfare publication (NIH) 75-628. Government Printing Office, 1974.
14 +
Ornish D:  Mind/heart interactions: For better and for worse . Health Values 1978;;2:266-269.
15 +
Ornish D: Stress, Diet, and Your Heart . New York, Holt Rinehart & Winston Inc, 1982;.
16 +
Nie NH: SPSS: Statistical Package for the Social Sciences , ed 2. New York, McGraw-Hill Book Co, 1975;, pp 320-367, 398-433.
17 +
Dixon WJ (ed): Biomedical Computer Programs . Berkeley, University of California Press, 1975;, p 711.
18 +
Castelli WP, Doyle JT, Gordon T, et al:  HDL cholesterol and other lipids in coronary heart disease: The cooperative lipoprotein phenotyping study . Circulation 1977;;55:767-772.
19 +
Ornish DM, Gotto AM, Miller RR, et al:  Effects of a vegetarian diet and selected yoga techniques in the treatment of coronary heart disease , abstracted. Clin Res 1979;;27:720A.
20 +
Nerem RM, Levesque MJ, Cornhill JF:  Social environment as a factor in diet-induced atherosclerosis . Science 1980;;208:1475-1476.
21 +
Marshall RC, Wisenberg G, Schelbert R, et al:  Effect of oral propranolol on rest, exercise and post-exercise left ventricular performance in normal subjects and patients with coronary artery disease . Circulation 1981;;63:572-583.
22 +
Upton MT, Rerych SK, Newman GE, et al:  The reproducibility of radionuclide angiographic measurements of left ventricular function in normal subjects at rest and during exercise . Circulation 1981;;62:126-132.
23 +
McAnulty JH, Kremkau EL, Rosch J, et al:  Spontaneous changes in left ventricular function between sequential studies . Am J Cardiol 1974;; 34:23-28.
24 +
Verani MS, Hartung GH, Harris JK, et al:  Effects of exercise training on left ventricular performance and myocardial perfusion in patients with coronary artery disease . Am J Cardiol 1981;;47:797-803.
25 +
Oliva PB:  Pathophysiology of acute myocardial infarction, 1981 . Ann Intern Med 1981;; 94:236-250.
26 +
Schiffer F, Hartley LH, Schulman CL, et al:  Evidence for emotionally induced coronary arterial spasm in patients with angina pectoris . Br Heart J 1980;;44:62-66.
27 +
Haft JI, Fani K:  Intravascular platelet aggregation in the heart induced by stress . Circulation 1973;;47:353-358.
28 +
Williams DO, Most AS:  Responsiveness of the coronary circulation to brief vs sustained α-adrenergic stimulation . Circulation 1980;;63:11-16.
29 +
Moncada S, Vane JR:  Arachidonic acid metabolites and the interactions between platelets and blood vessel walls . N Engl J Med 1979;;300:1142-1147.
30 +
Haft JI:  Role of blood platelets in coronary artery disease . Am J Cardiol 1979;;43:1197-1206.
31 +
Stuart MJ, Gerrard JM, White JG:  Effects of cholesterol on production of thromboxane B2 by platelets in vitro . N Engl J Med 1980;; 302:6-10.
32 +
Zmuda A, Dembinska-Kiec A, Chytkowski A, et al:  Experimental atherosclerosis in rabbits . Prostaglandins 1977;;14:1035-1043.
33 +
Carroll KK:  Dietary protein in relation to plasma cholesterol levels and atherosclerosis . Nutr Rev 1978;;36:1-5.
34 +
Sirtori CR, Agradi E, Conti F, et al:  Soybean-protein diet in the treatment of type-II hyperlipoproteinemia . Lancet 1977;;1:275-277.
35 +
Simonsen S, Kjekshus JK:  The effect of free fatty acids on myocardial oxygen consumption during atrial pacing and catecholamine infusion in man . Circulation 1978;;58:484-491.
36 +
Liedtke AJ, Nellis S, Neely JR:  Effects of free fatty acids on mechanical and metabolic function in normal and ischemic myocardium in swine . Circ Res 1978;;43:652-661.
37 +
Martin B, Robinson S, Robertshaw D:  Influence of diet on leg uptake of glucose during heavy exercise . Am J Clin Nutr 1978;;31:62-67.
38 +
Vik-Mo H, Mjos OD:  Influence of free fatty acids on myocardial oxygen consumption and ischemic injury . Am J Cardiol 1981;;48:361-365.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Harvey W, cited by Eastwood MR,  Trevelyan H: Stress and coronary heart disease . J Psychosom Res 1971;;15:289-292.
2 +
Hackett TP, Rosenbaum JF:  Emotion, psychiatric disorders, and the heart , in Braunwald E (ed): Heart Disease . Philadelphia, WB Saunders Co, 1980;, pp 1923-1943.
3 +
Benson H:  Systemic hypertension and the relaxation response . N Engl J Med 1977;; 296:1152-1156.
4 +
Patel CH:  Reduction of serum cholesterol and blood pressure in hypertensive patients by behavior modification . J R Coll Gen Pract 1976;; 26:211-215.
5 +
Cooper MJ, Aygen MM:  A relaxation technique in the management of hypercholesterolemia . J Human Stress 1979;;4:24-27.
6 +
Shekelle RB, Shyrock AM, Paul O, et al:  Diet, serum cholesterol, and death from coronary heart disease: The Western Electric Study . N Engl J Med 1981;;304:65-70.
7 +
Sacks FM, Castelli WP, Donner A, et al:  Plasma lipids and lipoproteins in vegetarians and controls . N Engl J Med 1975;;292:1148-1151.
8 +
Sacks FM, Rosner B, Kass EH:  Blood pressure in vegetarians . Am J Epidemiol 1974;; 100:390-398.
9 +
Ellis FR, Sanders T:  Angina and vegan diet . Am Heart J 1977;;93:803-805.
10 +
Okada RD, Boucher CA, Strauss HW, et al:  Exercise radionuclide imaging approaches to coronary artery disease . Am J Cardiol 1980;; 46:1188-1204.
11 +
Goldstein A: Biostatistics . New York, Macmillan Publishing Co Inc, 1964;, pp 6-8.
12 +
Borer JS, Bacharach SL, Green MV, et al:  Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease . N Engl J Med 1977;;296:839-844.
13 +
Manual of Laboratory Operations, Lipid Research Clinics Program, vol 1, in Lipid and Lipoprotein Analysis, US Dept of Health, Education, and Welfare publication (NIH) 75-628. Government Printing Office, 1974.
14 +
Ornish D:  Mind/heart interactions: For better and for worse . Health Values 1978;;2:266-269.
15 +
Ornish D: Stress, Diet, and Your Heart . New York, Holt Rinehart & Winston Inc, 1982;.
16 +
Nie NH: SPSS: Statistical Package for the Social Sciences , ed 2. New York, McGraw-Hill Book Co, 1975;, pp 320-367, 398-433.
17 +
Dixon WJ (ed): Biomedical Computer Programs . Berkeley, University of California Press, 1975;, p 711.
18 +
Castelli WP, Doyle JT, Gordon T, et al:  HDL cholesterol and other lipids in coronary heart disease: The cooperative lipoprotein phenotyping study . Circulation 1977;;55:767-772.
19 +
Ornish DM, Gotto AM, Miller RR, et al:  Effects of a vegetarian diet and selected yoga techniques in the treatment of coronary heart disease , abstracted. Clin Res 1979;;27:720A.
20 +
Nerem RM, Levesque MJ, Cornhill JF:  Social environment as a factor in diet-induced atherosclerosis . Science 1980;;208:1475-1476.
21 +
Marshall RC, Wisenberg G, Schelbert R, et al:  Effect of oral propranolol on rest, exercise and post-exercise left ventricular performance in normal subjects and patients with coronary artery disease . Circulation 1981;;63:572-583.
22 +
Upton MT, Rerych SK, Newman GE, et al:  The reproducibility of radionuclide angiographic measurements of left ventricular function in normal subjects at rest and during exercise . Circulation 1981;;62:126-132.
23 +
McAnulty JH, Kremkau EL, Rosch J, et al:  Spontaneous changes in left ventricular function between sequential studies . Am J Cardiol 1974;; 34:23-28.
24 +
Verani MS, Hartung GH, Harris JK, et al:  Effects of exercise training on left ventricular performance and myocardial perfusion in patients with coronary artery disease . Am J Cardiol 1981;;47:797-803.
25 +
Oliva PB:  Pathophysiology of acute myocardial infarction, 1981 . Ann Intern Med 1981;; 94:236-250.
26 +
Schiffer F, Hartley LH, Schulman CL, et al:  Evidence for emotionally induced coronary arterial spasm in patients with angina pectoris . Br Heart J 1980;;44:62-66.
27 +
Haft JI, Fani K:  Intravascular platelet aggregation in the heart induced by stress . Circulation 1973;;47:353-358.
28 +
Williams DO, Most AS:  Responsiveness of the coronary circulation to brief vs sustained α-adrenergic stimulation . Circulation 1980;;63:11-16.
29 +
Moncada S, Vane JR:  Arachidonic acid metabolites and the interactions between platelets and blood vessel walls . N Engl J Med 1979;;300:1142-1147.
30 +
Haft JI:  Role of blood platelets in coronary artery disease . Am J Cardiol 1979;;43:1197-1206.
31 +
Stuart MJ, Gerrard JM, White JG:  Effects of cholesterol on production of thromboxane B2 by platelets in vitro . N Engl J Med 1980;; 302:6-10.
32 +
Zmuda A, Dembinska-Kiec A, Chytkowski A, et al:  Experimental atherosclerosis in rabbits . Prostaglandins 1977;;14:1035-1043.
33 +
Carroll KK:  Dietary protein in relation to plasma cholesterol levels and atherosclerosis . Nutr Rev 1978;;36:1-5.
34 +
Sirtori CR, Agradi E, Conti F, et al:  Soybean-protein diet in the treatment of type-II hyperlipoproteinemia . Lancet 1977;;1:275-277.
35 +
Simonsen S, Kjekshus JK:  The effect of free fatty acids on myocardial oxygen consumption during atrial pacing and catecholamine infusion in man . Circulation 1978;;58:484-491.
36 +
Liedtke AJ, Nellis S, Neely JR:  Effects of free fatty acids on mechanical and metabolic function in normal and ischemic myocardium in swine . Circ Res 1978;;43:652-661.
37 +
Martin B, Robinson S, Robertshaw D:  Influence of diet on leg uptake of glucose during heavy exercise . Am J Clin Nutr 1978;;31:62-67.
38 +
Vik-Mo H, Mjos OD:  Influence of free fatty acids on myocardial oxygen consumption and ischemic injury . Am J Cardiol 1981;;48:361-365.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems