Reversal of Coronary Heart Disease: Four Important Points To Remember

Reversal of Coronary Heart Disease: Four Important Points To Remember

Cardiovascular diseases claim more lives each year than all forms of cancer and Chronic Lower Respiratory Disease combined (AHA, 2019).  Despite this, a diagnosis of coronary artery disease should not be considered a death sentence. A common question that arises in clinical practice is whether coronary artery disease can be reversed. In this article, I will share a clinical vignette and provide insights to this important topic. 

Years ago, I cared for a patient who I will call John. John was a 55-year-old man with a history of aortic valve disease and obesity with a body mass index of 40. He had maintained a vegetarian diet for years, was on medication for high blood pressure, and a statin for high cholesterol. John had chronic symptoms including shortness of breath and fatigue. With imaging we noted that his aortic valve had worsened to the point where he would likely need a valve replacement. We decided to proceed with a diagnostic cardiac catheterization as well as referral to a cardiac surgeon. 

John’s cardiac catheterization showed about 50 to 60% blockage of his proximal left anterior descending artery (LAD). The remaining arteries had mild plaque buildup, which was not felt to be high-grade.

I referred him to the cardiac surgeon who felt that although John had significant stenosis (narrowing) of his aortic valve, weight loss would be critical before undergoing surgery. The surgery was postponed until John could lose enough weight to reduce the risk of surgery.

John embarked on a weight loss program focusing on caloric restriction and regular exercise. He was successful losing about 60 pounds over the next year. In follow up, the cardiac surgeon advised that we should repeat his cardiac catheterization prior to moving forward with the surgery.

When I repeated John’s cardiac catheterization, I was delighted to see that his proximal LAD blockage was now only about 10 to 20%! It was a dramatic change from the previous angiogram. Based on the findings, it was obvious that John would not require any type of bypass surgery at the time of his aortic valve surgery.

Based on my own clinical experiences and the published medical literature, it is clear that there are well-defined strategies, which allow us to stabilize and even reverse coronary heart disease. Here are 4 key points to consider with regard to reversal of coronary artery disease:

1. A whole food, plant-based diet is often recommended for reversal of coronary heart disease. Available literature suggests that a plant-based diet can be a successful part of the program to reverse coronary artery disease. I am unaware of any medical literature suggesting that a diet high in animal fat or animal protein can reverse coronary heart disease.
2. Reversal of coronary heart disease is likely to require attention to more than just diet. Programs that focus on coronary risk reduction often involve routine exercise, stress reduction, smoking cessation, and other modalities. The benefit in terms of cardiovascular risk reduction may not just be from dietary intervention, but also from other lifestyle changes.
3. Medical therapy is beneficial for coronary prevention. There is abundant literature showing that LDL reduction achieved through statins and newer agents such as PCSK9 inhibitors can reduce the risk of coronary events. Some patients prefer natural approaches for cardiovascular prevention and do not wish to take medications, however there is data supporting the benefits of combining lifestyle modification with medical therapy to reduce atherosclerosis and cardiovascular risk. 
4. Lifestyle modification is likely more important than medical therapy for regression of coronary disease. In the clinical case presented, the patient was maintained on statin therapy for many years and had acceptable cholesterol levels, but still had significant coronary disease on the initial angiogram. Reversal of coronary disease only occurred after substantial lifestyle modification was incorporated. In my own clinical practice, I have seen many patients who are on medical therapy, but continue to smoke and/or maintain an unhealthy diet and these patients continue to be at very high risk for coronary events. Lifestyle modification is a key intervention for any patient who is looking to reverse coronary artery disease or modify their risk of coronary events. 

In conclusion coronary heart disease is the leading cause of death for both men and women in the U.S.  We have strong evidence that the risk associated with coronary heart disease can be reduced and in many patients we can even see a reversal of coronary atherosclerosis. A program to reverse coronary atherosclerosis may involve attention to a whole foods plant-based diet, exercise, stress reduction, smoking cessation, and medical therapy. 

 

References:

1. Ornish, L.W. Scherwitz., J.H. Billings, et al. Intensive lifestyle changes for reversal of coronary heart disease JAMA 280(1998), pp 2001-2007
2. S.K. Gupta, R.C. Sawhney, L. Rai, et al. Regression of coronary atherosclerosis through healthy lifestyle in coronary artery disease patients- Mount Abu Open Heart Trial Indian Heart J, 62(2011), pp 461-469
3. S.J. Nicholls, R. Puri, T Anderson et al. Effect of Evolocumab on Progression of Coronary Disease in Statin-Treated Patients. The GLAGOV Randomized Clinical Trial. JAMA 2016; 316(22): 2373-2384
4. Furhman, J. (2016) The End of Heart Disease Harper Collins