Insurance approval for the Ornish Program: Medicare Part B covers The Dean Ornish Program for Reversing Heart Disease, under a new benefit category, Intensive Cardiac Rehabilitation (ICR). Eligibility includes acute myocardial infarction within the preceding 12 months, a coronary artery bypass surgery, current stable angina pectoris, heart valve repair or replacement, percutaneous transluminal coronary angioplasty or coronary stenting, a heart or heart-lung transplant, or other cardiac conditions as specified through a national coverage determination. (16)
The Therapeutic Lifestyle Changes Diet for coronary heart disease (17,18):
- Consistent with the American Heart Association’s 2006 Diet and Lifestyle Recommendations which can reduce the risk of cardiovascular disease.
- The diet consists of cutting back sharply on saturated fat, which may elevate LDL cholesterol levels and increase the risk of heart attack and stroke. Intake of saturated fat is kept below 7% of the total calorie intake. Total fat intake should consist of 25-35% of daily total calories.
- Daily cholesterol intake should be kept below 200 milligrams.
- Sodium intake is limited to 2400 mg per day. Calorie intake should be kept to a level needed for maintaining healthy weight and reduce blood cholesterol level. (18)
Exercise and the Therapeutic Lifestyle Changes Diet (TLC):
The effect of adding 30 minutes of daily exercise at 50-75% of age-predicted maximum heart rate, to a Therapeutic Lifestyle Changes Diet (TLC) for 6 months was examined by Welty, FK et al. The authors of the study randomized participants with high-normal or stage 1 hypertension to either a treatment diet rich in fruit, vegetables, low-fat dairy products, reduced saturated/total fat or a control diet low in fruit, vegetables, and dairy products with fat content typical of the average US diet. A TLC diet with the addition of exercise assisted 89% of participants to reach an LDL cholesterol goal of under 130 mg/dL without lowering HDL levels or needing to add or increase lipid lowering therapy. The authors emphasized that exercise and weight loss should be encouraged with the TLC diet to achieve the LDL goal. Mean total cholesterol, LDL cholesterol and triglycerides decreased by 9.2% (p=0.08), 9.3% (p<0.018), and 18.8% (p<0.05), respectively; mean HDL cholesterol increased 2.6% (p=0.41). Women had a 12.3% reduction in LDL cholesterol and an 11.4% increase in HDL cholesterol compared with a 7.9% reduction in LDL cholesterol and no change in HDL cholesterol in men. Additionally, systolic and diastolic blood pressure (BP) decreased 9% (p<0.001) and 13%, respectively (p <0.0001). These BP reductions were two-fold greater than in the Diet and Systolic Hypertension study (DASH) The addition of exercise also achieved a 50% reduction in angina. (17)