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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) V 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 N 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 b .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 V 40%, can make changes in lifestyle to achieve similar medical and psychosocial benefit to patients with an LVEF N 40%.

At 3 months, there were more cardiac events in the UCG (6 events) than in the IG (1 event; P < .006; odds ratio = 13.27; confidence interval = 1.57-111.94). This difference was maintained over 3 years (P < .06; odds ratio = 2.75; confidence interval = 1.05-7.19). Of the 26 surviving (1 cardiac death) IG patients, 23 did not require primary revascularization. In conclusion, CHD patients with asymptomatic reduced LVEF may be able to safely delay revascularization by making changes in lifestyle with no increased risk for cardiac events or overt heart failure over 3 years.