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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.132852v1 AJPH.2007.132852v2 99/7/1263    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Govil, S. R. Articles by Ornish, D. PubMed PubMed Citation Articles by Govil, S. R. Articles by Ornish, D. Related Collections Insurance Access to Care Prevention Socioeconomic Factors Cardiovascular Disease

Sarah R. Govil, MPH, Gerdi Weidner, PhD, Terri Merritt-Worden, MS and Dean Ornish, MD

Sarah R. Govil is a student at the Yale School of Nursing, New Haven, CT, and is with the Preventive Medicine Research Institute, Sausalito, CA. Gerdi Weidner is with the Preventive Medicine Research Institute, Sausalito, and the Johannes Gutenberg-University, Mainz, Germany. Terri Merritt-Worden and Dean Ornish are with the Preventive Medicine Research Institute, Sausalito.

Correspondence: Requests for reprints should be sent to Gerdi Weidner, PhD, Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA 94965 (e-mail: g.weidner{at}yahoo.com).

Objectives. We sought to clarify whether patients of low socioeconomic status (SES) can make lifestyle changes and show improved outcomes in coronary heart disease (CHD), similar to patients with higher SES.

Methods. We examined lifestyle, risk factors, and quality of life over 3 months, by SES and gender, in 869 predominantly White, nonsmoking CHD patients (34% female) in the insurance-sponsored Multisite Cardiac Lifestyle Intervention Program. SES was defined primarily by education.

Results. At baseline, less-educated participants were more likely to be disadvantaged (e.g., past smoking, sedentary lifestyle, high fat diet, overweight, depression) than were higher-SES participants. By 3 months, participants at all SES levels reported consuming 10% or less dietary fat, exercising 3.5 hours per week or more, and practicing stress management 5.5 hours per week or more. These self-reports were substantiated by improvements in risk factors (e.g., 5-kg weight loss, and improved blood pressure, low-density lipoprotein cholesterol, and exercise capacity; P < .001), and accompanied by improvements in well-being (e.g., depression, hostility, quality of life; P < .001).

Conclusions. The observed benefits for CHD patients with low SES indicate that broadening accessibility of lifestyle programs through health insurance should be strongly encouraged.