Participants are taught about healthy eating habits, relaxation techniques and exercise. Instead of the standard cholesterol-lowering medications called statins, they take supplements such as fish oil and red yeast rice, a natural substance with statinlike effects.
About 2,200 people have taken the course, and, according to a 2006 trial, it was at least as effective as standard therapy in lowering cholesterol, and far more effective in weight reduction.
The research also showed Becker that people lost ground in the months after the program ended. So he plans to add a formal support group, lasting at least a year, to keep participants "on the right path."
Still, insurers generally don't pay the cost - $300 to $350 - and few physicians know about the program.
"It's been a labor of love," says Becker, a trim man of 54 with short, gray hair. "I haven't made much money on it.
"In the higher echelons of some of the health systems and the insurance companies, it hasn't quite reached through that you can save money on prevention" of heart disease, he says. "They're much more receptive on smoking cessation because it's easier to document."
With mild exasperation barely peeking through, he leaned over the desk in his Flourtown office and rattled off some percentages: 78, 23, 22, 40 and 3.
Seventy-eight is the percentage of nonsmokers in the United States. Twenty-three percent follow a careful diet along the lines of the low-fat Mediterranean diet that Becker espouses. Twenty-two percent exercise regularly, and 40 percent are not overweight.
Just 3 percent fall into all four groups, Becker says, "and if you look at that 3 percent, the incidence of heart disease is almost nil. If we could even take that 3 percent and get it to 4 percent," that would be a substantial achievement.
Becker is particularly concerned about physicians simply reacting to their patients' elevated cholesterol levels by prescribing statins, which are highly effective but can have side effects such as muscle aches and memory loss, and must be taken for life.
"Unless you're cursed with terrible genetics, I would argue that cholesterol doesn't matter as much," Becker says. "No one's looking at the bigger picture."
For those taking the Change of Heart course, the big picture usually starts in a venue such as a church auditorium rather than a physician's office.
After introductions by Becker and fellow cardiologist Ram Gordon, participants have group sessions with an exercise physiologist, a dietitian and experts on such stress-relaxation techniques as meditation, tai chi and yoga.
The recommended Mediterranean diet stresses fruits and vegetables, with a reduced intake of fats and meat in general. Simple carbohydrates such as white bread and rice are replaced by complex carbohydrates such as brown rice and whole-grain breads. Becker considers this regimen more practical than some other heart-healthy diets, which he calls "almost impossible to follow."
The recommended exercise levels are 30 to 45 minutes four times per week.
"I swear by it," said Steve DePaul, 51, of Lansdale, a financial adviser with a major bank. "If I didn't see the results, I wouldn't believe them."
DePaul said he took the program about six years ago at the recommendation of his father, who had taken it four years earlier. The elder DePaul, now 85, had bypass surgery 29 years ago.
Steve DePaul said he has been able to maintain the lifestyle changes recommended in the program. For example, since the dietitian showed him how much sugar was in a typical soft drink, "I've had maybe two or three sodas." His total cholesterol, which was 229 when he entered the program, is now 170.
"I've kept it down, and I've never been on medication," he said.
"It was a neat environment," he added. "Everybody supported everybody. We all had challenges."
A more recent participant was Charles "Chip" Roller, 67, of Roxborough, a retiree from the Pennsylvania Department of Public Welfare and part of a just-ended one-year study.
Roller had been taking a statin, Lipitor, and found that it made him "cranky and crabby." He took the supplements Becker recommends, red yeast rice and fish oil.
His total cholesterol dropped from 206 to 173; his LDL ("bad" cholesterol) fell from 313 to 95; and his triglycerides dropped from 122 to 73. His HDL ("good" cholesterol) went from 51 to 63. He also lost about 15 pounds.
Becker finds that patients tend to have fewer side effects with the supplements but cautions that they present one problem. Unlike medications, they are largely unregulated by the government. Quality can be spotty, so he will often recommend particular brands. Some fish oil, he says, is not only worthless but also harmful, contaminated with mercury.
A crude test: Cut open a capsule - be sure to wear gloves, he warns - and put the liquid in the freezer. If it freezes solid, it's "junk."
Even "brown rice" and "whole-wheat pasta" may not be what they seem, he warns: "You have to read labels carefully."
The trial Roller participated in looked at the effectiveness of red-yeast rice, and the final results aren't in.
But a study completed in 2006 compared patients who took red-yeast rice and fish oil and participated in Change of Heart with a group that took a statin and were given standard literature on healthy lifestyles.
Both groups had similar drops in LDL cholesterol - about 40 points - but the Change of Heart group lost more weight, an average reduction of 5.5 percent as opposed to less than 1 percent, and had a greater drop in triglycerides.
"By giving statins as a knee-jerk response, we're perpetuating an overweight, sedentary society," Becker says. "What's needed is a ground-level approach to getting people to change their lifestyle."
Contact Paul Jablow at email@example.com.