Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial

In a prospective, randomised, controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year, 28 patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) and 20 to a usual-care control group. 195 coronary artery lesions were analysed by quantitative coronary angiography. The average percentage diameter stenosis regressed from 40-0 (SD 16-9)% to 37-8 (16-5)% in the experimental group yet progressed from 42-7 (15-5)% to 46-1 (18-5)% in the control group. When only lesions greater than 50% stenosed were analysed, the average percentage diameter stenosis regressed from 61-1 (8-8)% to 55-8 (11-0)% in the experimental group and progressed from 61-7 (9-5)% to 64-4 (16-3)% in the control group. Overall, 82% of experimental-group patients had an average change towards regression. Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs. Lancet 1990; 336: 129-33.