Larry Scherwitz

Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification

This study is a randomized, controlled, blinded, arteriographic trial to determine the effects of a low-cholesterol, low-fat, vegetarian diet, stress management and moderate aerobic exercise on geometric dimensions, shape and fluid dynamic characteristics of coronary artery stenoses in humans. Complex changes of different primary stenosis dimensions in opposite directions or to different degrees cause stenosis shape change with profound effects on fluid dynamic severity, not accounted for by simple percent narrowing. Accordingly, all stenosis dimensions were analyzed, including proximal, minimal, distal diameter, integrated length, exit angles and exit effects, determining stenosis shape and a single integrated measure of stenosis severity, stenosis flow reserve reflecting functional severity. In the control group, complex shape change and a stenosis-molding characteristic of statistically significant progressing severity occurred with worsening of stenosis flow reserve. In the treated group, complex shape change and stenosis molding characteristic of significant regressing severity was observed with improved stenosis flow reserve, thereby documenting the multidimensional characteristics of regressing coronary artery disease in humans.

Type A behavior, self-involvement, and cardiovascular response.

&NA; Coronary‐prone Type A and noncoronary‐prone Type B students were challenged by a battery of tasks including cold pressor, mental arithmetic, behavior type interview, and the generation and expression of emotions. Measures of blood pressure, heart rate, and digital vasoconstriction were intercorrelated with reported distress, performance, speech characteristics, emotional intensity, and self‐references. The major difference between the two behavior types concerned self‐references, measured as the frequency of personal pronouns employed in speech. The Type As who referred to themselves frequently had a markedly higher systolic blood pressure, a slightly higher diastolic blood pressure, a lower heart rate, higher distress ratings to cold water, and more extreme voice emphasis and emotional intensity than Type As who referred to themselves less frequently. The Type Bs have little relationship of self‐references to any of the measures taken. The possible role of self‐involvement in generating Type A behavior and cardiovascular response is discussed.

Type A behavior, self-involvement, and coronary atherosclerosis.

&NA; Prior to coronary angiography, 150 men were assessed for Type A behavior using the structured interview and two questionnaire measures. The results show no relationship between Type A behavior and extent of coronary artery disease (CAD). A second finding is that the number of self‐references (I, me, my) derived from speech in the structured interview correlated positively with the number of previous myocardial infarctions and the extent of CAD; self‐references correlated negatively with time on the treadmill and catheterization ejection fraction. Multiple regression analyses show self‐references to remain a significant correlate of extent of disease when controlled for age, blood pressure, cholesterol, and Type A behavior.

Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients.

OBJECTIVE To focus on psychological well-being in the Lifestyle Heart Trial (LHT), an intensive lifestyle intervention including diet, exercise, stress management, and group support that previously demonstrated maintenance of comprehensive lifestyle changes and reversal of coronary artery stenosis at 1 and 5 years. DESIGN AND MAIN OUTCOME MEASURES The LHT was a randomized controlled trial using an invitational design. The authors compared psychological distress, anger, hostility, and perceived social support by group (intervention group, n = 28; control group, n = 20) and time (baseline, 1 year, 5 years) and examined the relationships of lifestyle changes to cardiac variables. RESULTS Reductions in psychological distress and hostility in the experimental group (compared with controls) were observed after 1 year (p < .05). By 5 years, improvements in hostility tended to be maintained relative to the control group, but reductions in psychological distress were reported only by experimental patients with very high 5-year program adherence. Improvements in diet were related to weight reduction and decreases in percent diameter stenosis, and improvements in stress management were related to decreases in percent diameter stenosis at both follow-ups (all p < .05). CONCLUSION These findings illustrate the importance of targeting multiple health behaviors in secondary prevention of coronary heart disease.

Social support group attendance is related to blood pressure, health behaviours, and quality of life in the Multicenter Lifestyle Demonstration Project

Changes in coronary risk factors, health behaviours, and health-related quality of life (HRQOL) were examined by tertiles of social support group attendance in 440 patients (21% females) with coronary artery disease. All patients participated in the Multicenter Lifestyle Demonstration Project (MLDP; eight hospital sites in the USA), an insurance-covered multi-component cardiac prevention program including dietary changes, stress management, exercise and group support for 1 year. Significant improvements in coronary risk factors, health behaviours, and HRQOL were noted at 1 year. Several of these improvements (i.e. systolic blood pressure, health behaviours, HRQOL) were related to social support group attendance, favoring those who attended more sessions. The associations between support group attendance to systolic blood pressure and to four HRQOL subscales (bodily pain, social functioning, mental health, and the mental health summary score) remained significant when controlling for changes in health behaviours, but dropped to a non-significant level for the HRQOL subscales ‘physical functioning’, ‘general health’ and ‘role-emotional’. These results suggest an independent relationship of social support group attendance to systolic blood pressure while improvements in quality of life may be in part due to improved health behaviours facilitated by increased social support group attendance.

Adherence and Acceptability of a Low-Fat, Vegetarian Diet Among Patients With Cardiac Disease

Low-fat, vegetarian diets have demonstrated potency in improving cardiovascular status, but little information is available regarding their acceptability or the levels of adherence that can be achieved. The current report was part of a larger study of a group of 27 patients with cardiac disease who

Self-reference and coronary heart disease incidence in the Western collaborative group study

&NA; Previous research has indicated that the spoken frequency of the self‐references “I,” “me,” and “my” in a structured interview was prospectively related to coronary heart disease (CHD). To assess whether the findings would replicate in another population, we conducted a case‐control analysis of 750 structured interviews from the Western Collaborative Group Study. To measure self‐references, auditors counted all first person pronouns (I, me, my) and clauses spoken in the audiotaped baseline structured interviews. Matched multiple logistic regression analyses, with or without adjustment for major CHD risk variables, indicated that those who incurred CHD did not self‐reference more frequently or densely than the CHD‐free control subjects. Type As spoke more clauses and more total self‐references but did not have a higher density of self‐references than Type Bs. The results question both the method for measuring self‐references and the hypothesis that self‐referencing are associated with CHD.

Effects of stress management training and dietary changes in treating ischemic heart disease

To evaluate the short-term effects of an intervention that consists of stress management training and dietary changes in patients with ischemic heart disease (IHD), we compared the cardiovascular status of 23 patients who received this intervention with a randomized control group of 23 patient who did not. After 24 days, patients in the experimental group demonstrated a 44% mean increase in duration of exercise, a 55% mean increase in total work performed, somewhat improved left ventricular regional wall motion during peak exercise, and a net change in the left ventricular ejection fraction from rest to maximum exercise of +6.4%. Also, we measured a 20.5% mean decrease in plasma cholesterol levels and a 91.0% mean reduction in frequency of anginal episodes. In this selected sample, short-term improvements in cardiovascular status seem to result from these adjuncts to conventional treatments of IHD.

Community attitudes toward the Attica prison riot - a mini-study

This study examined the attitudes of the people who lived and worked in Attica, New York, toward the disturbance at the correctional facility. An open-ended questionnaire and semantic differential asked for opinions about the riot, its causes, and the prison itself. Results indicated that most o f the people interviewed viewed the guards, correctional facilities, and general physical treatment as good, fair, and valuable, while the riot was viewed uniformly as bad, worthless, and unfair. Younger interviewees felt humanitarian reform was important slightly more often than oMer residents. However, the general homogeneity o f the samples attitudes toward the riot and its effects is discussed.

Devising an Appropriate Control Group in a Study of Acupuncture and Stroke Rehabilitation

Objective. To rigorously evaluate the efficacy of acupuncture for stroke rehabilitation. Method. Reviewed the randomized controlled clinical trials evaluating the efficacy of acupuncture and designed a study to address the challenge of placebo control. Results. Eight of nine randomized trials have shown that acupuncture treatment appears to benefit stroke recovery. However, these studies have not adequately controlled for the placebo response, so it is not clear whether the acupuncture treatment itself specifically treats post-stroke paralysis. The challenge of controlling for placebo responses is that while the patients can be blinded to experimental conditions, the acupuncturists can not. Accordingly, this study of acute stroke patients maintains the therapist’s intent to heal, but directs the attention in a control group to the co-morbid problem of insomnia. Using procedures to maintain double blinding (of patient and outcome assessor), stroke patients receiving standard stroke rehabilitation therapy are randomized to three groups: