I was taught in medical school that coronary artery disease (CAD), or the blockages that can choke off blood flow to the heart, progresses from minor “streaks” in youth, to visible plaques young adulthood, and on to complicated plaques and major problems later in life. During my training the arrow always pointed towards heart disease advancing and never reversing. This is just not true! Indeed, for nearly 3 decades it has been known that just as arteries can worsen with time, they can also improve rapidly. Some of the measures to achieve this are presented here.
While reversal of clogged heart arteries has been shown before, most of the studies actually look at other endpoints like risk of heart attack and even survival in patients with calcified arteries treated with statins. A study just published looked at a database of 13, 644 patients studied for heart artery disease by a coronary calcium CT scan and followed for over 9 years. The group was also analyzed as to whether they were on a statin medication to lower their cholesterol. As the picture above demonstrates, when the score, a measurement of how much calcium was in the heart arteries, was calculated as abnormal at 100–400, or over 400, being treated with a statin was associated with a lower risk of bad outcomes. In fact, when the calcium score was over 100, only 12 patients needed to receive a statin to prevent one event like a heart attack, stroke, or death.
This one-way street towards worsening was shown to be incorrect in 1990 by Dean Ornish, M.D. He prescribed a plant-based diet without added fats to patients with proven heart blockages. He also recommended walking, social support and stress management to help their hearts. He demonstrated that the patients who adhered to his “lifestyle program” felt better and showed reductions in the amount of narrowing in their arteries. Dr. Ornish followed his patients for longer periods of time and with further testing and showed even more improvements, avoidance of hospitalizations, and reduced costs. Since those first reports, the data that heart disease can be reversed by intensive lifestyle changes emphasizing a plant-based diet low in added fats has become so robust that the Ornish Lifestyle program was recognized by Medicare in 2010 for reimbursement as a therapy of CAD. Another similar program, based out of the Pritikin Longevity Center in southern Florida, received the same Medicare designation for intensive therapy and reversal of heart disease with dietary therapy.
Because both the work done by Dr. Ornish, and the original site of the Pritikin Center was in California, it could be argued that the plant based dietary reversal of heart disease is only a West coast thing. Fortunately, a similar research program at the Cleveland Clinic Foundation led by Dr. Caldwell Esselstyn monitoring patients with advanced heart disease who converted to totally plant based diets without added oils identified the same types of clinical improvements with documents shrinking and reversal of heart blockages.
Although all whole plant foods can contribute to heart disease reversal, special mention is earned by a few. The ability of garlic to lower blood pressure, cholesterol, and blood clotting has been recognized for some time. There have actually been a surprising number of studies testing the ability of aged garlic extract to halt heart disease progression. For example, in a study published in early 2016 that used baseline and follow-up CT angiograms of heart arteries, aged garlic extract reduced areas of plaque in heart arteries at the one-year follow-up. In addition to the sulfur content of garlic, onions also provide a source of sulfur in the diet that may be crucial for maintaining optimal amounts of antioxidants.
Pomegranate juice and seeds both have powerful antioxidant properties that may improve the function of HDL cholesterol. This protective cholesterol may boost the reverse cholesterol transport, or “vacuum cleaner” function in arteries, that may reverse CAD. In studies of mice, pomegranates can reduce atherosclerosis although translating animal research to human health can be misleading. In humans with increased stress at risk for CAD, pomegranates can reduce evidence of arterial damage. In another study using pomegranate juice for three years, the degree of narrowing in carotid arteries of five study subjects was reduced.
Beyond diet, there may be other methods supported by scientific studies to reverse atherosclerosis. Over 60 years ago some data surfaced that chelation therapy (latin for claw) using disodium ethylene diamine tetraacetic acid or EDTA could reverse heart artery disease. It took many decades but the Trial to Assess Chelation Therapy (TACT) was published in 2013 and demonstrated an improvement in outcomes in post-myocardial infarction (MI) patients following IV EDTA versus a placebo. The TACT showed a particularly large reduction in CVD events and all-cause mortality in the subgroup of patients with diabetes. An ongoing TACT2, limited to patients with heart disease and diabetic mellitus type 2, is further examining this unique therapy in the hope that it may enter the armamentarium to reduce the atherosclerotic risk of their diabetic patients.
There is an interesting oral agent containing EDTA and additional agents that has data for lowering the calcification of coronary arteries in peer reviewed data. Other components of the novel combination may attack the mechanism of calcification and lead to reversal of plaque. I have successfully used NanobacTX in heart patients in my clinic.
Other promising therapies for the reversal of atherosclerosis using nutraceutical therapies have appeared. In a recently published randomized study from China, 76 patients with carotid atherosclerosis were treated with either nattokinase (NK) 6,000 FU or simvastatin 20 mg (). In both groups cholesterol fell, and in the NK group HDL rose, but reversal of atherosclerosis over 26 weeks was profound with NK and plaque volume fell by 37%.
In another study from China in 2009, 60 patients with carotid plaque were divided aspirin and atorvaststatin. Half also got lumbrokinase, 2 capsules three times a day for 6 months. Lumbrokinase is an enzyme extracted from earthworms. Measurements of CIMT were lower in the group treated with lumbrokinase as were measures of cholesterol fractions and platelet aggregation. The use of lumbrokinase was safe in this small study.
Another agent, bergamot, was studied in patients with atherosclerosis over 6 months without randomization. Lipid fractions improved as anticipated during therapy with bergamot and there was a stunning decrease in the CIMT from 1.2 cm to 0.9 cm.
Vitamin E has 8 forms and 4 of them are classified as tocotrienols with properties far more favorable than the more common tocopherols. In a study of 50 patients with carotid disease, half were treated with a source of gamma tocotrienol from palm oil. Over 18 months of therapy, regression of plaque was seen in 7 of the 25 patients treated with the vitamin E preparation while in the control group none regressed and 10 showed worsening.
A promising combination therapy has been reported to promote the reversal of carotid atherosclerosis. The study combined pycnogenol with centella asiatica and followed 391 patients with ultrasound measurements of plaque for over 4 years in a randomized trial. The progression of plaque over time was least in the patients treated with the combination nutraceutical and there was reduction in the number of angina episodes and myocardial infarctions in the treated cohort.
Recently a study of a green algae extract in a capsule given twice a day for 2 months was examined in terms of impact on the “lipid rich necrtoic core” of carotid plaque using MRA to assess the arteries before and after. The preliminary findings of this ongoing study in China indicate significant decreases of 50% or more in this measure of disease and provides a hopeful avenue of therapy by emphasizing the endothelium and its glycocalyx.
Advances in the detection, prevention and reversal of atherosclerosis are sorely needed. These studies give hope that even for patients with advanced disease, nutrition, chelation, and nutraceutical therapies can improve their quality and quantity of life.