Cardiac Wellness

Identifying Cardiac Risk Factors

Prevention of cardiovascular disease through evidence-based lifestyle interventions has been strongly recommended by the U.S. Preventive Services Task Force, a panel of national experts in prevention and evidence-based medicine. Yet, establishing effective interventions relies upon identification of elevated risk factors in asymptomatic individuals. (1)

Knowledge of Cardiac Risk Genes Improves Care and Outcomes

The precision medicine approach to assessing cardiac risk has been shown to be six times more accurate than a conventional risk factor assessment. Conventional risk factors for atherosclerosis correctly predict only ~11% of cardiac events, whereas the addition of genetic susceptibility markers increases predictive value to 63%. (2,3)

Cardiac Health: Taming the Stress Response

Maintaining Cardiac Wellness through Exercise

Rekindle your kid energy.

Stress Management and Resiliency Training (SMART) is a well-studied approach for managing stress in cardiac patients. The physiological effects associated with training the relaxation response (counterpart to the “fight-or-flight” response) include lower heart and respiratory rates and resting blood pressure. At the genomic level, SMART training has been shown to effect changes in energy metabolism, insulin secretion, and inflammatory pathways. (4,5,6,7)

Cardiac Wellness Program

Like other cardiac wellness programs, SMART includes dietary advice, an exercise prescription and other interventions to achieve lipid control, weight loss, and stress modification.

SMART vs. Ornish

SMART vs Ornish Spectrum: Cardiac RehabilitationIn an eight-year study (2000-2008) carried out by Brandeis University, two well-established lifestyle modification programs were compared. One is the Dr. Dean Ornish Program for Reversing Heart Disease (Ornish) and the other is Cardiac Wellness Program of the Benson-Henry Mind Body Institute (SMART). (8)

Significant Improvements in Biomarkers

Statistically significant improvements in low-density lipoprotein (LDL), body-mass index (BMI), and blood pressure were found in both programs.

More Consistent Results in SMART Participants

However, the proportion of patients who achieved goal levels of LDL (100 mg/dl or less) during the study increased in the SMART program to 82%, while changes in the Ornish program participants were less consistent. And by the end of the third year of follow-up, there were significant differences.

Fewer Cardiac Events in SMART Participants

Three years after induction into their respective programs, participant’s mortality rates and hospitalizations for cardiac-related events were significantly different.  Namely, the mortality rate for the Ornish participants (8%) was three times higher than for the SMART program participants (2.7%). (9)

Psychological Health Improvements

In a separate study of 800 cardiac patients completing the Benson-Henry Mind/Body Medicine Institute (SMART) program, improvements in measures of depression (-47%), anxiety (-36%), and hostility(-25%) were reported. (10)


  1. Fihn SD, Gardin JM, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012 Dec 18;60(24):e44-e164.
  2. Razavi M, Fournier S, Shepard DS, Ritter G, Strickler GK, Stason WB. Effects of lifestyle modification programs on cardiac risk factors. PLoS One. 2014 Dec 9;9(12):e114772.
  3. Kullo IJ, Cooper LT. Early identification of cardiovascular risk using genomics and proteomics. Nat Rev Cardiol. 2010 Jun;7(6):309-17.
  4. Chang BH, Jones D, Hendricks A, Boehmer U, Locastro JS, Slawsky M. Relaxation response for Veterans Affairs patients with congestive heart failure: results from a qualitative study within a clinical trial. Prev Cardiol 2004;7:64–70.
  5. van Dixhoorn JJ, Duivenvoorden HJ. Effect of relaxation therapy on cardiac events after myocardial infarction: a 5-year follow-up study. J Cardiopulm Rehabil 1999;19:178–85.
  6. Chang BH, Casey A, Dusek JA, Benson H. Relaxation response and spirituality: Pathways to improve psychological outcomes in cardiac rehabilitation. J Psychosom Res. 2010 Aug;69(2):93-100.
  7. Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW, Fricchione GL, Benson H, Libermann TA. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS One. 2013 May 1;8(5):e62817.
  8. Razavi M, Fournier S, Shepard DS, Ritter G, Strickler GK, Stason WB. Effects of lifestyle modification programs on cardiac risk factors. PLoS One. 2014 Dec 9;9(12):e114772.
  9. Zeng W, Stason WB, Fournier S et al. Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries. Am Heart J. 2013 May;165(5):785-92.
  10. Chang BH, Casey A, Dusek JA, Benson H. Relaxation response and spirituality: Pathways to improve psychological outcomes in cardiac rehabilitation. J Psychosom Res. 2010 Aug;69(2):93-100.