Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project.

This study examined medical and psychosocial characteristics of 440 patients (mean age 58 years, 21% women) with coronary artery disease at baseline and at 3-month and 12-month follow-ups. All patients were participants in the Multicenter Lifestyle Demonstration Project, aimed at improving diet (low fat, whole foods, plant-based), exercise, stress management, and social support. Spousal participation was encouraged. Both genders evidenced significant improvements in their diet, exercise, and stress management practices, which they maintained over the course of the study. Both women and men also showed significant medical (e.g., plasma lipids, blood pressure, body weight, exercise capacity) and psychosocial (e.g., quality of life) improvement. Despite their worse medical, psychosocial, and sociodemographic status at baseline, women's improvement was similar to that of men's. These results demonstrate that a multi-component lifestyle change program focusing on diet, exercise, stress management, and social support can be successfully implemented at hospitals in diverse regions of the United States. Furthermore, this program may be particularly beneficial for women with coronary artery disease who generally have higher mortality and morbidity than men after a heart attack, angioplasty, or bypass surgery.

Vital exhaustion in relation to lifestyle and lipid profile in healthy women.

"Vital exhaustion," characterized by fatigue, irritability, and demoralization, precedes new and recurrent coronary events. Biological mechanisms explaining this association are not fully understood. The objective was to investigate the relationship between vital exhaustion, lifestyle, and lipid profile. Vital exhaustion, smoking, body mass index (BMI), alcohol consumption, exercise capacity, and serum lipids were determined in 300 healthy women, aged 56.4 +/- 7.1 years. No statistically significant associations were found between vital exhaustion and lifestyle variables. Divided into quartiles, vital exhaustion was inversely related to high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 in a linear fashion after adjustment for age, BMI, exercise capacity, and alcohol consumption. A multivariate-adjusted vital exhaustion-score in the top quartile, as compared to one in the lowest, was associated with 12% lower HDL-C and 8% lower apolipoprotein A1 (p < .05). In conclusion, alterations in lipid metabolism may be a possible mediating mechanism between vital exhaustion and coronary heart disease. The impact of lifestyle variables was weak.

Cortisol and vital exhaustion in relation to significant coronary artery stenosis in middle-aged women with acute coronary syndrome.

BACKGROUND: The role of chronic stress in coronary artery disease (CAD) is not well known. Conflicting results have been obtained with regard to the stress hormone cortisol and 'vital exhaustion', a psychological construct defining the effects of long-term stress. We investigated the relationship between chronic stress, assessed by serum cortisol and vital exhaustion, and coronary artery stenosis and the importance of chronic stress in relation to standard risk factors of CAD. METHODS AND RESULTS: Women, or=50%) had elevated cortisol levels compared to the others (p=0.009). A 25% increase of cortisol increased the probability of significant coronary stenosis by 41% (p=0.005). Compared to standard risk variables of CAD, only high-density lipoprotein cholesterol (HDL-C) was a more important predictor. Each 25% decrease of HDL-C increased the probability of significant coronary stenosis by 65% (p=0.0021). Vital exhaustion was not related to coronary stenosis (p=0.47). However, it appeared to have an additive effect as women with both a cortisol level and vital exhaustion score above the sample median, had a near three-fold risk of having CAD, OR=2.85 (95% CI 1.31-6.18), compared to those who did not have this combination. The results remained after adjusting for age, glucose, and use of calcium channel- and beta-blockers. CONCLUSION: Cortisol, but not vital exhaustion, was independently related to coronary stenosis in women with acute coronary syndrome. The influence of cortisol was important compared to standard risk factors of CAD.