A Prospective Evaluation of Health Services Outcomes and Emerging Cardiovascular Disease Biomarkers

Inclusion Criteria: * Eligible patients included those who had a diagnosis of coronary heart disease (CHD) from their physician or health plan, a diagnosis of diabetes, or at least 3 additional cardiac risk factors. * A diagnosis of CHD included: * having diagnosed CHD based on non-invasive testing such as exercise testing, nuclear imaging, echocardiogram or other test that clearly demonstrates ischemia * cardiac catheterization demonstrating CHD * eligibility for bypass surgery/PTCA and seeking a clinical alternative * coronary bypass surgery * PTCA/stent * myocardial infarction. * Type I or Type II diabetics were eligible for the program. * For a participant to be included as a high-risk factor participant, the participant must have either a family history of premature CHD (1st-degree relative (male\<55; female \<65) with MI or sudden cardiac death) or be a male aged \> 45 or a female aged \> 55. * In addition, there must be at least two additional cardiovascular risk factors, including: * current cigarette smoking (within the past 5 years) * hypertension: BP \> 140/90 mm Hg or on antihypertensive medication, * low HDL-C: \<35 mg/dl or on medications for lipid therapy * elevated apolipoprotein(a): \>30 mg/dl or on medications for elevated lipids * high total cholesterol: \> 240 or on medications for elevated lipids * high LDL-C: \>160 or on medications for elevated lipids * high sensitivity C-Reactive Protein: \> 3 mg/dl and \< 10 mg/dl * obesity: BMI \> 30 * Insulin Resistant State (Metabolic Syndrome X Exclusion Criteria: * Exclusion criteria included: * ischemic left main CHD, with an obstruction greater than 50% * significant (\>70%) proximal left anterior descending artery disease and proximal left circumflex artery disease and an ejection fraction less than 50%, \*unstable angina * hypotensive response to exercise (\> 20mm Hg drop in systolic BP) * history of exercise induced ventricular tachycardia or 3rd degree heart block without evidence of current stability * CABG surgery within 4 weeks, unless approved by medical director * MI within one month, unless approved by medical director\\ * HF, with functional limitation and unresponsive to medications * current tobacco user not concurrently enrolled in a smoking cessation program with 2-month history of smoking cessation * uncontrolled malignant ventricular arrhythmia despite medications and/or implantable cardiac defibrillator (ICD), unless approved by medical director, resides beyond a one-hour commute to the Program site, unless approved by Team, \*history of substance abuse disorder (inc. ETOH) without documentation of a minimum one year of abstinence * history of a significant psychiatric disorder without documentation of minimum one-year stability * impaired cognitive function, such as dementia or delirium * English language literacy unless Program site can accommodate * non-ambulatory * uncooperative spouse or life partner, defined as obstructive in attitude or behavior * the patient is deemed to be potentially disruptive to group setting by the screening team.