Socioeconomic Status and Improvements in Lifestyle, Coronary Risk Factors, and Quality of Life: The Multisite Cardiac Lifestyle Intervention Program

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 wellbeing (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. (Am J Public Health. 2009;99:1263-1270. doi: 10.2105/AJPH.2007.132852)