Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of ≤40% or >40% in the Multicenter Lifestyle Demonstration Project

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 LVEF≤40% (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 LVEF≤40%, can make changes in lifestyle to achieve similar medical and psychosocial benefit to patients with an LVEF>40%.