Long-term effects of an integrative medicine and lifestyle modification intervention in patients with coronary artery disease on cardiovascular risk factors, need of medication and coronary calcium

Background The randomized SAFE-LIFE trial tested the effectiveness of a 1-year outpatient Integrative Medicine program with focus on Mind–Body Medicine (MBM) in patients with Coronary Artery Disease (CAD). One-year results showed clinically relevant improvements in cardiac autonomic function, quality of life, need of medication and cardiac symptoms for patients in the intervention group [Michalsen et al., Am Heart J 2006;151:870-7]. With the final 3-year follow-up we evaluated the long-term effects of the intervention including its impact on coronary artery atherosclerosis. Methods 101 patients with medically and interventionally treated CAD were assigned into two groups: (1) Intensive program (IP) group ( n =48; 59±8.7 years) with 100 h lifestyle modification and MBM training over 12 months. (2) Usual care (UC) group ( n =53; 59.8±8.6 years) with written informations only. Three-year outcomes included blood pressure, heart rate, cardiac symptoms, quality of life and coronary calcification as assessed by coronary electron-beam computed tomography. Results Baseline characteristics were comparable. Adherence to proposed lifestyle diminished over time but was still improved after year 3 in the IP group over UC. Patients in the IP group showed a significant decrease in heart rate ( p p p p Conclusion A 1-year Integrative lifestyle modification program in CAD patients led to lasting improvements in blood pressure, cardiac autonomic function and need of medication. The progression of coronary atherosclerosis was not affected by lifestyle intervention but by the presence of co-existing affective disorders. The impact of Integrative lifestyle modification and interventions focussing the treatment of depression and anxiety in CAD should be tested in a larger randomized controlled trial.