| Clinical Outcomes |
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Twelve Week Clinical Outcomes - Cohort 1 - Fall 2002
According to the American Heart Association, heart disease is the number one killer of men and women in the US. Unfortunately this burden falls disproportionately hard on a number of rural areas including Appalachia. West Virginia has had the misfortune of ranking at or near the top of this list for the last several years. In order to address this problem, a unique coalition of health insurers, hospitals, administrators, and clinicians have banded together to take a new approach to this issue. Rather than simply responding to the consequences of this high rate of morbidity and mortality associated with heart disease, they asked the question, how can we take action to combat heart disease in other ways?
The answer came about through this unprecedented coalition of West Virginians working with Dr. Dean Ornish and Lifestyle Advantage to bring one of the best-researched heart disease treatment programs in the country to West Virginia. Through a grass roots approach utilizing local hospitals and clinicians along with cooperation from health insurers, Lifestyle Advantage helped bring this program to West Virginians throughout the state.
The program kick-off occurred just one year ago at the Governor’s Wellness Council and much has been accomplished since then. There was a great deal of skepticism in the beginning: “it worked elsewhere, but it can’t work here,” “West Virginians will never make these changes,” “the state is too traditional to adopt this lifestyle,” “its too hard.” The people who made these statements underestimated the will and the determination of the Mountain State. Now, exactly one year later, there is a broad network of highly trained clinicians throughout West Virginia providing the Dean Ornish Program principles to people from Wheeling to Princeton.
The clinical outcomes for the first 50 participants in the West Virginia Dr. Dean Ornish Program have just been evaluated and the findings are remarkable. The data from the first 12-week outcomes reveals that West Virginians are as motivated and capable of accomplishing these lifestyle changes as participants in other parts of the country. An overview of these findings is as follows.
The Dr. Dean Ornish Program for Reversing Heart Disease is a comprehensive research based approach that uses lifestyle changes to reduce known cardiac risk factors. An important part of our work involves the ongoing measurement and analysis of the results. In this case, we have 12-week outcomes from the first 50 participants in the Mountain State. And, in summary, these participants performed superbly. Their outcomes meet or exceed those results achieved in other parts of the country where we have offered the Ornish Program.
Let’s review some of these findings and see what the West Virginia participants were able to achieve.
Dietary Changes
One part of the program that attracts considerable attention is the emphasis on a low fat high complex carbohydrate diet. Many critics felt that this approach could not be successful in West Virginia. However, what did the data show?
West Virginians were able to reduce their dietary intake of fat by 68%.
Exercise Changes
Since a sedentary lifestyle is a key factor in heart disease, were WV participants able to change their exercise levels?
West Virginians increased their weekly exercise by 79% (up to an average of 244 minutes per week).
Weight Loss and Body Fat
Did these dietary and exercise changes yield results?
Yes. Each West Virginia participant lost an average of 15.2 lbs in the first twelve weeks (for a collective reduction of 760 lbs.)
In addition, they also reduced their body fat by 10.6%, resulting in a leaner, fitter Mountaineer.
What About Cholesterol Levels?
Were West Virginians able to reduce their cholesterol levels?
The answer is a resounding yes. And here, as in other areas, West Virginians excelled at reducing their cholesterol levels. Total cholesterol fell an average of 33.2 points per participant (resulting in the first 50 participants shedding a collective 1660 points [or mg/dl] of cholesterol). In addition, LDL (also called the “bad cholesterol”) levels were reduced by 23.8%. And Triglycerides, another type of lipid, were lowered by 13% through the commitment and dedication of the participants.
Blood Pressure
Knowing what an adverse impact high blood pressure has on cardiovascular events, were the participants able to reduce their blood pressure through their efforts with the program?
Systolic blood pressure levels were found to drop by 10.2 mmHg (or 7.7%) while diastolic pressures fell an average of 8.3 mmHg (or 10%). The average results are near ideal levels as defined by the American Heart Association.
What about Psychosocial Factors?
It has become increasingly clear that high rates of stress, anger and depression can aggravate cardiac conditions. Part of the work in the Dr. Dean Ornish program is learning how to manage those factors in a healthier way. Through the combination of program elements (eating right, exercising more, participating in group support and actively working on stress management) West Virginians learn how to manage these common but hazardous aspects of everyday life.
Psychosocial outcome measures:
West Virginians increased their stress management activities from 17 minutes per week to 358 resulting in an increase of 2037%. Measurements on the Perceived Stress Scale fell an average of 36% during the first 12 weeks. In addition, ratings on the Hostility Scale (Cook-Medley) showed a 26% reduction and the Depression Scale (CES-D) yielded a 45% decrease. These results indicate that West Virginians embraced the strategies for managing these psychosocial factors and had excellent results using the tools.
| How Did West Virginians Stack Up Against Other Sites? |
The efforts and outcomes of West Virginia participants ranked among the best we have seen anywhere. A brief comparison of some of the outcomes with a program in a nearby state showed the following results:
|
West Virginia (%) |
Other State (%) |
| Total Cholesterol |
-18.2 |
-11.4 |
| LDL |
-24 |
-15 |
| Triglycerides |
-13 |
-5 |
| Weight |
-7.2 |
-5.2 |
| Systolic Blood Pressure |
-7.7 |
-7.3 |
| Depression |
-45 |
-48.3 |
| Hostility |
-26 |
-19 |
|
What Does It All Mean?
Do the results of these efforts mean there will be less heart disease or just that people will feel better?
While it is impossible to predict who will have a heart attack or stroke at any given time, there is extensive research that allows for the calculation of the likelihood of having a heart attack or stroke. This research has been compiled over the years through the work on the Framingham Study. These efforts have allowed researchers to develop sophisticated tools for modeling or predicting the chance of a cardiac event occurring (called the ATP III Framingham Risk Tool). If we look at the 50 West Virginians collectively, before they entered the Ornish Program, and then calculate their collective risk 12 weeks later, WE FIND A 50% REDUCTION IN THEIR RISK OF CARDIAC EVENTS.
In summary, through the implementation of this broad based alliance, West Virginians have begun to reverse the tide of heart disease in their state. Ten hospital–based teams of health professionals have been trained and are successfully implementing the Dr. Dean Ornish Program for Reversing Heart Disease. Program participants have demonstrated the ability to make great changes in their lives and have already begun to experience the results of these efforts. And, in addition to the 50 participants who have completed their first 12 weeks, there are currently an additional 100 WV residents participating at the 10 hospital sites throughout the Mountain State.
Mark G. Fuller, MD, FACP
Medical Director
Lifestyle Advantage*
*Lifestyle Advantage is a joint venture between the Pittsburgh, Pa.-based health insurer Highmark Blue Cross Blue Shield and the Sausalito, Calif.-based Preventive Medicine Research Institute, of which Dean Ornish, M.D. is founder and president. Lifestyle Advantage is the exclusive nationwide marketing and distribution entity for the Dr. Dean Ornish Program for Reversing Heart Disease. Its mission is to increase and equalize national access to the Ornish Program and other lifestyle modification programs. Please visit
www.lifestyleadvantage.org or call 800.879.2217 for more information.