Can a supercharged lifestyle program beat standard heart care?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Subjects must be competent to provide written informed consent. * Subjects must sign an Institutional Review Board (IRB) approved Informed Consent Form (ICF) and HIPAA Authorization prior to the initiation of any study procedures. * Men and women age ≥40 \_ Indication for stress perfusion testing * Appropriate Indications for stress perfusion testing: * Suspected CAD: * Men with any chest pain syndrome and two other risk factors * Women \>50 years old with any chest pain syndrome and two other risk factors * Asymptomatic men and women \>50 years with at least three other risk factors\* or Coronary Calcium Agatston score \>400. * Diabetic men and women and two other risk factors * Documented known CAD: * Men and women asymptomatic or stable symptoms and known CAD by abnormal catheterization or prior SPECT without revascularization after \>2 years to evaluate worsening disease or * Men and women with worsening symptoms and known CAD by abnormal catheterization or prior SPECT/PET without revascularization * Men and women with chest pain syndrome and previous revascularization * Asymptomatic men and women \>5 years after coronary artery bypass graft surgery (CABG) or \>2 years after PCI * Risk factors: Diabetes, Current or recent cigarette smoking (within the last 12 months), LDL\>130, low HDL \<50 women, HDL \<45 men, history of metabolic syndrome, hypertension (SPB\>140), family history of premature (\<60 year) CAD, Atherosclerotic carotid artery disease OR atherosclerotic peripheral vascular disease (APVD) as defined by ankle-brachial index below 0.9 and/or by abnormal duplex ultrasound, CT angiography, magnetic resonance angiography (MRA) or conventional invasive angiogram or previous revascularization procedure. * Framingham's high risk criteria refers to presence of diabetes mellitus with the limitation described above (c) or 10 year absolute Coronary Heart Disease(CHD)risk of \>or= 20% (see tables Appendix A). * Chest pain is defined as Typical Angina if Exertional + Retrosternal + relieved with rest or sublingual nitroglycerin (NTG) , Atypical angina if only two of the above criteria are present and Non-anginal if one or none of the above are present. Exclusion Criteria: * Age \<40 * Low pretest likelihood of CAD (= not meeting the above criteria) * Unstable angina high risk (dynamic ST-Twave ECG changes and/or elevated troponin) * Recent MI (\<4 weeks) * Recent stroke (\<4 weeks) * CABG or percutaneous coronary intervention (PCI) within the last 6 months * Severe renal dysfunction as defined by creatinine \> 2.0 mg/dl * Active liver disease or hepatic dysfunction, AST or ALT \> x 2 the upper limit of normal (ULN) * Concomitant valvular heart disease * Left ventricular ejection fraction (LVEF) \<30% * Severe systemic hypertension defined as systolic blood pressure (SBP) \> 200 mmHg * Symptomatic sustained or non-sustained ventricular tachycardia * Morbid Obesity defined by Body Mass Index \> 35 * Sever disability to prevent therapeutic exercise not expected to resolve within 6 months * Major non-cardiac co-morbidity limiting survival or social situation/condition that in the opinion of the investigator will preclude the patient from participation in the study follow-up. * Concurrent or prior (within last 30 days) participation in other research studies using investigational drugs or devices.