Josiah Brown Poster Abstract

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Alex M. Mirman
Tamara Horwich, MS, MD
Nolan Nardoni, Alessandra Y. Chen
Comparing the Efficacy of Cardiac Rehabilitation Programs on Body Composition and Cardiac Biomarkers in Patients with Coronary Artery Disease
Internal Medicine Chief's Fellowship

Background: Cardiac rehabilitation (CR) is a critical component of coronary artery disease (CAD) management that has been shown to reduce the risk of hospitalization and death. The clinical efficacy of the two cardiac rehabilitation programs at UCLA – a well-established, more “traditional” exercise-based program and a new intensive, comprehensive lifestyle-modification program – have not been readily compared. We tested the hypothesis that in CAD patients, the intensive program, called the UCLA Health Ornish Lifestyle Modification Program, would lead to greater improvements in body composition and cardiovascular risk factors than the traditional UCLA CR program.

Methods and Results: We included 715 patients with CAD who completed either of two CR programs at UCLA since April 2014. 74.8% were men with a median age of 68 and average body mass index (BMI) of 27.5 ± 5.9 kg/m2. Numerous markers of cardiovascular health including body composition using bioelectrical impedance analysis (BIA) were assessed pre- and post- program participation. Participants in both programs significantly lowered their blood pressure, BMI, body fat, and cholesterol levels. However, intensive rehabilitation patients, compared to patients completing the traditional program, had greater reductions in weight, body mass index, body fat percentage, visceral fat area, and diastolic blood pressure (P<0.01 for these measures). Notably, Ornish patients lost an average of more than 5 times as much visceral fat area as the traditional patients did (11.05 cm2 compared to 2.01 cm2). However, patients completing the traditional program demonstrated greater increases in HDL cholesterol, lean body mass percentage, skeletal muscle mass percentage and a greater decrease in their edema index (ratio of extracellular to total body water), with P<0.03 for all of these measures.

Conclusions: In patients with CAD, both the traditional and intensive CR programs at UCLA had significant effects on many cardiovascular risk factors and measures of body composition. Overall however, the Ornish program demonstrated greater improvements in measures of body fat, particularly visceral fat, which is known to be an important component of cardio-metabolic health. Future research will focus on which of these changes in body composition and cardiac risk factors are important to long-term outcomes in patients with CAD.

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