Avoiding revascularization with lifestyle changes: the multicenter lifestyle demonstration project

  • Dean Ornish
    Address for reprints: Dean Ornish, MD, University of California-San Francisco School of Medicine; Preventive Medicine Research Institute, 900 Bridgeway, Suite 1, Sausalito, California 94965
    Preventive Medicine Research Institute, Sausalito, California, USA
    Search for articles by this author
  • for the Multicenter Lifestyle Demonstration Project Research Group


      The Multicenter Lifestyle Demonstration Project was designed to determine if comprehensive lifestyle changes can be a direct alternative to revascularization for selected patients without increasing cardiac events. A total of 333 patients completed this demonstration project (194 in the experimental group and 139 in the control group). We found that experimental group patients were able to avoid revascularization for at least 3 years by making comprehensive lifestyle changes at substantially lower cost without increasing cardiac morbidity and mortality. These patients reported reductions in angina comparable with what can be achieved with revascularization.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Esselstyn Jr, C.B.
        • Ellis S.G.
        • Medendorp S.V.
        • Crowe T.D.
        A strategy to arrest and reverse coronary artery disease.
        J Fam Pract. 1995; 41: 560-568
        • Ornish D.
        • Brown S.E.
        • Scherwitz L.W.
        • Billings J.H.
        • Armstrong W.T.
        • Ports T.A.
        • McLanahan S.M.
        • Kirkeeide R.L.
        • Brand R.J.
        • Gould K.L.
        Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial.
        Lancet. 1990; 336: 129-133
        • Schuler G.
        • Hambrecht R.
        • Schlierf G.
        • Grunze M.
        • Methfessel S.
        • Hauer K.
        • Kubler W.
        Myocardial perfusion and regression of coronary artery disease in patients on a regimen of intensive physical exercise and low fat diet.
        J Am Coll Cardiol. 1992; 19: 34-42
        • Brown G.
        • Stewart B.F.
        • Zhao X.Q.
        • Hillger L.A.
        • Poulin D.
        • Albers J.J.
        What benefit can be derived from treating normocholesterolemic patients with coronary artery disease?.
        Am J Cardiol. 1995; 76: 93C-97C
        • Kane J.P.
        • Malloy M.J.
        • Ports T.A.
        • Phillips N.R.
        • Diehl J.C.
        • Havel R.J.
        Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens.
        JAMA. 1990; 264: 3007-3012
        • Blankenhorn D.H.
        • Nessim S.A.
        • Johnson R.L.
        • Sanmarco M.E.
        • Azen S.P.
        • Cashin-Hemphill L.
        Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts.
        JAMA. 1987; 257: 3233-3240
        • Buchwald H.
        • Varco R.L.
        • Matts J.P.
        • Long J.M.
        • Fitch L.L.
        • Campbell G.S.
        • Pearce M.B.
        • Yellin A.E.
        • Edmiston W.A.
        • Smink Jr, R.D.
        • et al.
        Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia.
        N Engl J Med. 1990; 323: 946-955
        • Gould K.L.
        • Martucci J.P.
        • Goldberg D.I.
        • Hess M.J.
        • Edens R.P.
        • Latifi R.
        • Dudrick S.J.
        Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease.
        Circulation. 1994; 89: 1530-1538
      1. American Heart Association. Heart and Stroke Facts. 1995 Statistical Supplement. Dallas: American Heart Association, 1994.

        • Gould K.L.
        • Ornish D.
        • Scherwitz L.
        • Brown S.
        • Edens R.P.
        • Hess M.J.
        • Mullani N.
        • Bolomey L.
        • Dobbs F.
        • Armstrong W.T.
        • et al.
        Changes in myocardial perfusion abnormalities by positron emission tomography after long-term intense risk factor modification.
        JAMA. 1995; 274: 894-901
        • Bourassa M.G.
        Long-term vein graft patency.
        Curr Opin Cardiol. 1994; 9: 685-691
        • Hirshfeld Jr, J.W.
        • Schwartz J.S.
        • Jugo R.
        • MacDonald R.G.
        • Goldberg S.
        • Savage M.P.
        • Bass T.A.
        • Vetrovec G.
        • Cowley M.
        • Taussig A.S.
        • et al.
        Restenosis after coronary angioplasty.
        J Am Coll Cardiol. 1991; 18: 647-656
        • Alderman E.L.
        • Bourassa M.G.
        • Cohen L.S.
        • Davis K.B.
        • Kaiser G.G.
        • Killip T.
        • Mock M.B.
        • Pettinger M.
        • Robertson T.L.
        Ten year follow up of survival and myocardial infarction in the randomized Coronary Artery Surgical Study.
        Circulation. 1990; 82: 1629-1646
        • Varnauskas E, for the European Coronary Surgery Study Group
        Twelve-year follow-up of survival in the randomized European Coronary Surgery Study.
        N Engl J Med. 1998; 319: 332-337
        • Chaitman B.R.
        • Fisher L.D.
        • Bourassa M.G.
        • Davis K.
        • Rogers W.J.
        • Maynard C.
        • Tyras D.H.
        • Berger R.L.
        • Judkins M.P.
        • Ringqvist I.
        • Mock M.B.
        • Killip T.
        Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease.
        Am J Cardiol. 1981; 48: 765-777
        • Coronary Artery Bypass Surgery Cooperative Study Group
        Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina.
        N Engl J Med. 1984; 311: 1333-1339
        • Fuster V.
        • Badimon L.
        • Badimon J.J.
        • Chesebro J.H.
        The pathogenesis of coronary artery disease and the acute coronary syndromes.
        N Engl J Med. 1992; 326: 242-318
        • Connor W.E.
        • Connor S.J.
        • Katan M.B.
        • et al.
        Clinical debate.
        N Engl J Med. 1997; 337: 562-563
        • Ornish D.
        Eat More, Weigh Less. Harper Collins Publishers, New York1993
        • Leaf A.
        Preventive Medicine for Our Ailing Health Care System.
        JAMA. 1993; 269: 616-618