Coronary Artery Bypass Grafting (CABG): Reassessing Efficacy, Safety, and Cost

David K. Cundiff

In This Article

The Effect of Aggressive CAD Risk Factor Reduction

The Lifestyle Heart Trial, led by Ornish, demonstrated in a randomized comparison with standard medical treatment that aggressive multifactorial CAD risk factor reduction (ie, smoking cessation, 10% fat vegetarian diet, moderate exercise, stress management training) produced a 91% reduction in the frequency of angina.[110,111] Cardiovascular capacity improved, and the average degree of coronary artery stenosis at 1 year on repeat angiography decreased by about 10% vs an increase of about 10% with standard treatment of CAD patients by cardiologists. At 4 years, the aggressive lifestyle modification group had only one half of the cardiac events as the conventional treatment group. Cardiac positron emission tomography showed significant improvement in myocardial perfusion in the treatment group but worsening in the control group.[112]

The remarkable potential for multifactorial CAD risk factor reduction demonstrated by the Ornish program and our improved understanding of the natural history of CAD provides more suggestive evidence in favor of the hypothesis that the temporary difference in survival of CABG vs medically treated patients was not due to revascularization. Rather, it may have been due to the motivating effect of cardiac surgery on reducing coronary risk behaviors.


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