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Research
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RESEARCH STUDY OF REVERSAL OF ARY HEART DISEASE THROUGH PREKSHA MEDITATION WITH REFRENCE TO
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CORONARY ATHEROSCLEROTIC REVERSAL POTENTIAL OF YOGA LIFE STYLE INTERVENTION
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S.C.Manchanda MD. R. Narang MD, K.S. Reddy MD, U Sachdeva MD, D. Prabhakaran MD, S. Dharmananda BA, M. Rajani MD, R.L. Bijalani MD.
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| Abstract |
Background: It is not clear if lifestyle modification has any role in control of symptoms, progression of coronary lesions and prognosis in patients with advanced obstructive coronary artery disease.
Methods: In the prospective, randomised, controlled trial, 42 men with angiographically proven coronary obstructive disease were randomized to control (n=21) and yoga intervention group (n=21) and were followed for 1 year. The yoga lifestyle programme was a user friendly program consisting of strict control of risk factors, diet control (15% calories from fat, mostly mono-and polyunsaturated 65% from carbohydrate, mostly complex, 20% from proteins, high fiber (> 50 g/day) and antioxidants), moderate aerobic physical exercise, health rejuvenating exercises, breathing and relaxation exercises, stress management, meditation and reflection on moral values. The patients were taught various yogic exercises at yoga centre which they later practiced everyday at home. The control group was managed by conventional methods, i.e. risk factors control and AHA step I diet.
Results: At the end of 1 year, the yoga groups showed significant improvement in number of anginal episodes, improved exercise capacity and decrease in body weight, and total and LDL cholesterol and serum triglyceride levels as compared to controls. Coronary angiography repeated at 1 year showed that significantly more lesions regressed (20% versus 2% and less lesion progressed (5% versus 37%) in the yoga group (chi-square = 24.9; P<0.0001). Revascularisation procedures (coronary angioplasty or bypass surgery) were much less frequent in the yoga group (1 versus 8 patients; relative risk 5.45; P=0.01) The compliance of the total programme was excellent and no side effects were observed.
Conclusions: Yoga lifestyle intervention is beneficial in improving the symptoms and exercise capacity, lowering weight and serum lipid levels. It also retards the progression of coronary atherosclerosis in- patients with severe coronary artery diseases and reduces revasularisation procedures.
Introductions
A number of studies have documented that a change in lifestyle (chiefly consisting of dietary modifications, physical exercises and stress relaxation techniques) results in reduction of cardiac events in patients with coronary artery disease (CAD). However, there is a paucity of studies to determine whether lifestyle modification can result in regression of the coronary atherosclerotic plaques. Ornish et al observed a regression of coronary aterosclerotic obstruction by strict lifestyle intervention. However the coronary stenoses were mild (40% and 43% diameter stenosis in treatment and control groups. Respectively) and the diet prescribed in their study was also very stringent. With only 5mg of cholesterol allowed per day. It is likely that such strict control of diet may not be practical for most patients. The present study was designed to assess the effects of strict but "user friendly" intervention using yoga lifestyle methods (with strict control of risk factors) on the angioraphic severity of atherosclerotic obstructions in patients with advanced CAD (>70% luminal diameter stenosis in at least 1 vessel). The effects on symptoms, exercise capacity serum lipids and cardiovascular events were also analyzed.
Aims & objectives
The objective of this study was to determine whether a user-friendly yogic lifestyle intervention program (including yogic exercises, dietary management, moderate aerobic exercise and stress management) with control of other risk factors can reverse the atherosclerotic obstructions in patients known to have coronary artery disease.
Material and Methods
Forty-two male patients (mean age 51.0 + 9.5 range 32-72 years) with angiographically proven CAD were included in this prospective, randomized, controlled trial. At baseline detailed clinical assessment, serum lipid profile, treadmill exercise testing using modified Bruce protocol and coronary arteriography were performed. Patients in the control group (n=21) were managed on conventional medical therapy (with control of risk factors, AHA step 1 diet, moderate aerobic exertion), while those in the yoga group (n=21) were advised strict lifestyle modifications and yogic exercises as detailed below. The medications for angina were continued. No patient was receiving lipid-lowering drugs. The patients were followed for 1 year with regular assessments. At the end of 1 year, the patients again underwent detailed clinical assessment, serum lipid profile, treadmill exercise test and repeat coronary arteriography. Coronary arteriography was analyzed quantitatively using the caliper method. All arteriograms were analyzed by two independent blinded observers. For coronary angiography the effect on individual lesions was compared in the 2 groups. Ethical clearance was obtained from the institutional ethics committee and all patients gave informed consent to take part in the study. The baseline characteristics of the patient population are detailed in table 1. Most patients were in NYHA functional class II(52% patients) or class III (41% patients). The patients in both groups had elevated mean total and low-density lipoprotein cholesterol. The study was conducted before the results of major trials of statins in coronary artery disease were published and none of the patients were on lipid lowering therapy. All patients had at least 1 mm ST segment depression during exercise testing. Coronary arteriography showed majority (81%) of patients to be have triple vessel disease.
| Yoga Lifestyle Intervention Program |
| The yogic lifestyle intervention program consisted of: Yogic lifestyle methods, health rejuvenating exercises: a set of movements for improving the general tone of the body and to improve coordination. |
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| Clinical Profile |
| Patients in the yoga group showed an improvement in the NYHA functional class while patients in the control group showed an overall worsening (p<0.0001). The number of episodes of angina per week reduced by 73% in the yoga group. |
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| Discussion |
| There are number of reports of a favourable effect of risk factor modification in patients with coronary artery disease (secondary prophylaxis) Ornish et al (1983) reported the short-term effects of stress management and dietary changes in patients with coronary artery diseases. |
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| Limitations of Study |
Relatively small number of patients have been studied. Though the result are encouraging the need to be replicated in larger number of patients.
The patients in the yoga group had more rigorous follow-up though the control group was also followed regularly. |
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| References |
| Superko HR, Wood PD,Haskell WL. Coronary heart disease and risk factor modification is there a threshold? Am J Med 1985: 78 826-38. |
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