A Change Of Heart
It's not too late to turn back the clock on your ticker

By Kathleen Christensen

"I see no signs of heart trouble," said the cardiologist to Paul Scofield, of Omaha, Nebraska, looking at the results of Scofield's treadmill test. Little did this doctor know that Scofield—then age 49—had had a heart attack just three months earlier.

"I was in a meeting at work, and I felt back pain," Scofield says. "Fortunately, I stopped by the hospital on my way home from the office." Doctors performed an angioplasty the next day.

While still in the hospital recovering, Scofield decided to embark on an ambitious program of lifestyle changes designed not merely to prevent or slow down the progression of his heart disease, but to reverse the damage. Five years later, it's paid off in more than just good results on a positron-emission tomography (PET) scan, an echocardiogram, and treadmill tests. "It's a better life," he says.

Research by Dean Ornish, MD, and colleagues (Lancet, 1990, vol. 336, no. 8708; Journal of the American Medical Association, 1998, vol. 280, no. 23) suggests that lifestyle changes can in fact reverse heart disease. According to the American Heart Association's Web site, "[Ornish's] project has shown that, with motivated patients willing to follow the regimen and a skilled group leader able to inspire adherence to it, significant benefits can be achieved to reduce atherosclerotic lesions in coronary arteries."

To understand the research, it helps to know a little about coronary artery disease. Its hallmark is atherosclerosis, in which fat, cholesterol, calcium, and other cellular debris build up as plaque inside the arteries that feed your heart. When plaque obstructs enough of the blood flow, you might experience the chest pain called angina. Complete blockage of an artery can lead to a heart attack.

Turn Back Time
Heart disease can not only be prevented—it can be reversed. Rigorous lifestyle changes, including stress management, diet modification, adequate exercise, and group support, can help you enjoy a better life.

In Ornish's studies, participants who made major lifestyle changes saw about an 8 percent shrinkage in their blockages after five years, whereas in a control group under the "usual care" of their own physicians, blockages grew by about 28 percent. Eight percent may not sound like much, but after five years, the usual-care group, per patient, had more than twice as many "cardiac events"—angioplasties, bypass surgeries, heart attacks, and deaths—as the group who made the lifestyle changes.
 

Here's why that 8 percent may be so powerful: "A little bit of reversal is critical in stabilizing the plaque," says William Haskell, PhD, director of Stanford University's Center for Research in Disease Prevention, "preventing the plaque from rupturing or breaking, which appears to trigger the majority of heart attacks.

"I don't think there's a lot of argument in the medical community about whether heart disease can be reversed," Haskell adds. The problem, he says, is that only a "small subset" of patients is likely to make the necessary lifestyle changes—and sustain them for life.

What Does It Take?
Reversing heart disease requires what for many heart patients is a "very vigorous lifestyle change," according to Lee Lipsenthal, MD, medical director of Lifestyle Advantage, an organization licensed to provide the Ornish program to consumers. The Ornish program recommends the following.

Stress management. The Ornish program suggests roughly an hour daily of stress-management activities—meditation, yoga, progressive relaxation, guided imagery, or deep breathing. An hour may sound like a lot, but the reason is simple, according to Lipsenthal: "People who did an hour or more got the most regression of heart disease." Stress management can also help you stick with the rest of the program. "You begin to reap perspective on how and why you do things," says Lipsenthal, "and from that point, you can begin to make diet and exercise changes."

Diet modification. A diet that's good for preventing heart disease may not be enough to reverse it. The diet used in Ornish's studies is a vegetarian one, emphasizing fruits, vegetables, whole grains, and beans, along with nonfat dairy products and egg whites. Just 10 percent of calories comes from fat. Interestingly, despite the absence of fish in the Ornish diet, the program does recommend 3 grams per day of fish-oil supplement for men (2 grams of fish oil plus 1 gram of flaxseed-oil supplement for women), as a source of heart-healthy omega-3 fatty acids.

Adequate exercise. "Exercise can be more powerful... than some or most of the medications we take," says Lipsenthal. In fact, it can halve your risk of experiencing a cardiac event. Based on recent research, Lipsenthal recommends five hours or more of modest exercise—brisk walking, swimming, or casual bike riding—every week.

Smoking cessation. Smoking more than doubles your risk of having a heart attack, according to the American Heart Association, and smokers are more likely than nonsmokers to die—and die quickly—from a heart attack. "We work with people to quit before joining the program," says Lipsenthal. "If someone can quit smoking for at least two months and then join the program, not only do they do well in the program, but they also do well in not going back to smoking."

Group support. Group support "is an integral part of the [Ornish] program," says Lipsenthal. Scofield and his wife, for example, participate in a weekly support group. Of course, the groups help participants make lasting lifestyle changes, but connecting with other people in a group is also therapeutic in and of itself, according to Lipsenthal. "Being socially connected really gets at social isolation and depression, and those are two big psychological risk factors for coronary disease."

Is This For You?
Already a vegetarian and an inventive cook, Scofield says the Ornish Program "was a natural thing for me." But he's the first to admit that it's not for everybody. How do you know if you're a candidate?

First, an exercise test must show that your heart disease is stable, says Lipsenthal, as it is in more than 95 percent of cases. A lack of blood flow at low levels of exercise indicates instability. Beyond that, he says, you must be motivated to make significant change—and have the energy to do so. He points out that as you make the changes, "you become more energized, more motivated."

If you've already had angioplasty or bypass surgery, don't think it's too late to make changes. After all, 60 percent of angioplasties are repeated in five years, and bypass surgeries last eight to 12 years on average, according to Lipsenthal. "If you make intensive lifestyle change after your procedure," he says, "you're very likely to avoid a second one."

Did You Know?
The full Ornish program is available in only a handful of states at this point; contact Lifestyle Advantage (see "Resources") to find out where, to learn about Ornish retreats, and to get the names of local practitioners familiar with the Ornish program. Your cardiologist, too, may know about local heart-disease-reversal programs.

Keep in mind that lifestyle change is not an all-or-nothing process. Scofield, for example, combines the Ornish program with medications to regulate his cholesterol and heartbeat. Don't minimize the impact of making less-drastic changes either; you can still slow down the progression of your heart disease. In a study led by Haskell, for example, researchers provided one group of patients with individualized programs of moderate lifestyle change combined with medication. After four years, those patients showed 47 percent less narrowing of their arteries than a group under the usual care of their own physicians (Circulation, 1994, vol. 89, no. 3).
 

The benefits of committing to a heart-disease-reversal program, though, are more than just medical. "You're in control of the progression of your disease instead of just a victim," says Scofield. And the treatment has had other beneficial side effects for him: Scofield's quick temper has mellowed, yoga has made his body more flexible, and he enjoys the camaraderie of his weekly support group.

Don't Go It Alone
To safely attempt a heart-disease-reversal program, it's crucial that you enlist the help of a supportive medical team. And make sure that any outside program you participate in coordinates with your own physician, says Haskell.

Seek out the support of loved ones as well. "People do better with heart disease if they have strong intimate connections in their lives," says Lipsenthal. "Men, more so than women, tend to find that connection in their marriage."

"Just being there with Paul has really helped him a lot," says Scofield's wife, Barbara; Paul agrees wholeheartedly. Together, the couple does yoga, takes walks, and attends support-group meetings—and Barbara reaps the health and emotional benefits as well. Making the lifestyle changes together, adds Paul, is "good for a marriage."

Scofield believes that following Ornish's guidelines as part of his treatment plan offers him the best chance of keeping his heart disease at bay. But he emphasizes how much better he feels right now—physically, emotionally, and interpersonally. The program "makes for a better life," Scofield says, "no matter what its length."