© 2007 European Society of Cardiology
Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of 
40% or >40% in the Multicenter Lifestyle Demonstration Project
Preventive Medicine Research Institute (PMRI) Sausalito, CA, United States
* Corresponding author. 900 Bridgeway, Sausalito, CA 94965, United States. Tel.: +1 415 332 2525; fax: +1 415 332 5730. E-mail address:gerdi.weidner{at}pmri.org
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Abstract |
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Background: Lifestyle changes are recommended for coronary heart disease (CHD) patients at risk for heart failure (HF) [ACC/AHA stage B; left ventricular ejection fraction (LVEF)
40%]. However, it is not clear whether changes in lifestyle are feasible and beneficial in these patients.
Aim: To investigate the feasibility of intensive lifestyle changes for CHD patients at risk for HF.
Methods: We compared 50 patients (18% female) with angiographically documented LVEF40% (mean=33.4±7.3; range: 15–40%) to 186 patients (18% female) with LVEF>40% (mean=58.2±9.6; range: 42–87%), who were participants in the Multicenter Lifestyle Demonstration Project (MLDP). All were non-smoking CHD patients. The MLDP was a community-based, insurance-sponsored intervention (low-fat, plant-based diet; exercise; stress management) implemented at 8 sites in the US. Coronary risk factors, lifestyle and quality of life (SF-36) were assessed at baseline, 3 and 12 months.
Results: Regardless of LVEF, patients showed significant improvements (all p<.05) in lifestyle behaviours, body weight, body fat, blood pressure, resting heart rate, total and LDL-cholesterol, exercise capacity, and quality of life by 3 months; most improvements were maintained over 12 months.
Conclusion: CHD patients at risk for heart failure with an LVEF40%, can make changes in lifestyle to achieve similar medical and psychosocial benefit to patients with an LVEF>40%.
Key Words: Heart failure (ACC/AHA stage B) • Left ventricular ejection fraction • Diet • Lifestyle • Coronary risk factors • Quality of life
Received October 9, 2006; Revised February 23, 2007; Accepted May 14, 2007
Preparation of this article was, in part, supported by a grant from the Department of the Army (U.S. Army Medical Research Acquisition Activity W81XWH-06-1-0565) and does not reflect the position or the policy of the government; the Department of Health and Human Services (Health Resources and Services Administration # 4 C76HF00803-01-01), the German Academic Exchange Service (DAAD), Deutsche Forschungsgemeinschaft (German Research Foundation), and the Alexander von Humboldt Foundation.