Can heart disease be reversed?
According to conventional medical theory,
coronary heart disease is an irreversible, progressive condition. That
explains the many thousands of major heart procedures performed every
But we’re on the dawn of a new age in which reversal of heart disease is
rapidly becoming a reality for more and more people. What exactly
happens when coronary heart disease is reversed? What does it look like
and how do you know when you’ve achieved it? Is there a scientific
rationale behind the Track Your Plaque approach? Here’s our Special
Report on everything you wanted to know about heart disease reversal.
Coronary heart disease is the cause of death of half of all males, a
third of all women. Beyond the toll in human life, it’s also the
costliest disease in financial terms, far outstripping cancer and other
human scourges. Reversal of coronary heart disease—essentially a
“cure”—should be the holy grail of medicine.
But you’d never think so, listening to physicians, hospital marketing,
or media reports. The focus is the next new stent, defibrillator,
robotic surgery, heart transplantation, etc. The whole business of
conventional heart care is based on a disease that is unstoppable
without procedures. Coronary disease is so relentless that a 10” long
chest incision is required. Rarely does a single stent or bypass provide
the final solution. Multiple procedures over several years are the rule.
"Modern cardiology has given up on
curing heart disease."
Caldwell B. Esselstyn, M.D.
But if you have a CT heart scan score greater than zero
and your coronary arteries thereby contain atherosclerotic plaque, it’s
natural to ask: Can my plaque be reduced? Can heart disease be reversed?
Studies first hinting that coronary disease regression was possible date
as far back as the 1970’s. Back then, however, shrinkage was spotty and
inconsistent. With treatment approaches available then, rapid
progression was much more common, and a modest slowing of plaque growth
was regarded as a success.
There’s also no shortage of misinformation about heart disease reversal.
Enter the search phrase “heart disease reversal” into Google and you’ll
get over 2 million citations. Countless programs make extravagant claims
of “reversing” coronary heart disease with everything from high dose
vitamin C, low-fat diets, meditation, to chelation.
How much can you believe? If somebody claims to achieve shrinkage of
plaque using treatment X, how can it be proven? How do you really know
whether coronary disease is reversed? Does surviving until your next
birthday suffice? Does the absence of symptoms mean anything? Does
losing 10 lbs tell you whether coronary plaque has shrunk? Should we
just follow a treatment program and assume that atherosclerotic plaque
has shrunk? How can you know if you have reversed plaque, not just
statistical likelihood but actual reversal?
Dr. Ornish had it right—for his time!
The long-time favorite book, Dr. Dean Ornish’s Program
for Reversal of Heart Disease, was released in 1995. Ornish details a
super low-fat (<10% of calories from fat) approach for “reversal” of
heart disease. To achieve this extreme level of fat deprivation, meat,
eggs, cheese, cooking oil, butter and other full-fat dairy products, and
margarine are completely eliminated. Only vegetables, fruits, and whole
grains are included.
In 1985, when Americans were indulging in hamburgers, cheese, sausage,
French fries, and discovering the joys of fast-food, the Ornish low-fat
diet represented an improvement. Eliminate all sources of fats and total
and LDL cholesterol drop 30%.
However, as more and more people followed the Ornish program, it became
clear that an extreme low-fat diet is also a high-carbohydrate diet.
Carbohydrates expand to fill 60–70% of calories to take up the slack
left by slashing fat. Most people experience lower healthy HDL and
higher triglycerides, both undesirable effects. Hidden patterns like
small LDL and VLDL emerge. Many people develop a constellation of
abnormalities called the metabolic syndrome, or pre-diabetes (Krauss RM
et al 1995). The net effect in many is not reversal, but worsening—more
rapid growth of coronary plaque.
How do you know if you’ve reversed coronary plaque on the Ornish
program? Is reducing LDL cholesterol sufficient to know that plaque has
shrunk? You won’t know. That is the fundamental problem with the Ornish
program and others like it. You will not know if you have or have not
reversed heart disease. Lowering cholesterol by itself, in fact, is not
sufficient to shrink plaque in most people.
The Ornish program was a good solution for its time, just like the 1957
Chevy was a great car for its era. But the time for this program is now
How do we prove that plaque is growing or shrinking?
We know that just feeling good cannot signify whether
plaque is growing or shrinking. We also know that indirect measures of
risk like cholesterol do not reflect plaque growth. Plaque can grow like
wildfire with low cholesterol. Eating healthy and exercise without
symptoms? It tells us nothing about plaque growth.
There are several basic requirements for a program for reversing heart
disease, i.e., reducing coronary atherosclerotic plaque. They are:
1. We need a method to measure atherosclerotic plaque.
The method should be precise, easy to obtain, and safe.
We don’t want a measurement tool that is inaccurate, expensive, or
dangerous. Intracoronary ultrasound, or ICUS, is an accurate tool for
measuring coronary plaque. But it involves invasive methods inserting
catheters, a 2–3% risk of heart attack and stroke (because catheters are
threaded deeply into arteries), and is costly ($10,000–$15,000).
Repeating it every year is an even tougher prospect.
Stress testing won’t do because stress tests (stress thallium or other
nuclear material, stress echo, etc.) are too crude as measures of
plaque. Stress tests are really tests of coronary blood flow. They show
abnormalities in the most advanced phases of disease, such that the
majority of people at risk for heart attack have normal stress tests.
Former President Bill Clinton provides a good example: five stress tests
(thallium nuclear tests which were thought to be the "gold standard" for
detecting heart disease)) over five years, all normal—until he needed
urgent bypass surgery because of severe blockage in all three coronary
arteries. In fact, the majority of people destined for future heart
attacks have normal stress tests. Stress tests are therefore useless for
tracking heart disease reversal.
2. The measurement we choose should reflect the amount of plaque
This seems obvious, but in years past, many studies
were performed using measuring tools that were poor reflectors of the
disease. For instance, researchers used stress tests to gauge whether
coronary disease had progressed or not. They reasoned that, if blood
flow measured by a stress test improved, then plaque must be shrinking.
At first blush, this seems to make sense. Unfortunately, it’s not true:
blood flow can improve simply because the artery dilates, or enlarges.
It tells you nothing about the amount of plaque in the artery wall.
Blood pressure medications were initially thought to reverse plaque
because they dilated arteries and thereby improved flow, even while
plaque grew. Plaque can grow substantially yet not result in any drop in
Likewise, images obtained through heart catheterization can appear to
show shrinkage of plaque if the artery enlarges. Dozens of studies
suggesting 1,2, or 3% plaque shrinkage really proved very little because
of artery dilatation.
Another reason both stress tests and catheterization can yield
misleading information is because of the “Glagov phenomenon”: as plaque
grows within an artery, the total diameter of the artery enlarges with
it. This means that any test that relies on measuring the internal
diameter of the artery, like stress tests and catheterization, can be
fooled. Plaque can grow yet not reveal itself by reducing the diameter
of the path for blood flow.
The Glagov Phenomenon
There are tests that fit our criteria of safety and
accuracy, but don’t reflect coronary plaque very well. Ultrasound of the
carotid arteries, and ultrasound and ankle-brachial index (blood
pressure measurement) in the legs, i.e., tests of arteries outside the
heart, do indeed identify risk for heart attack, but are poor measures
of actual coronary plaque—they’re simply too indirect. One level of
plaque in a leg artery, for instance, does not necessarily correlate
well with plaque in the coronaries.
There’s only one way to accurately and safely measure coronary plaque
that meets all our requirements: CT heart scans for coronary calcium
scoring. Year to year, they accurately reflect plaque growth or
reversal, don’t rely on artery diameter measures and are not fooled by
the Glagov phenomenon. CT heart scans are also performed with only
modest radiation exposure, meet our criterion for safety, and are
available at a cost within reach for most people.
What happens when plaque “reverses”
If plaque reverses, it obviously should shrink in size.
But what actual changes occur in the plaque?
Most of this information has been obtained from observations in animals,
since we are unable to extract plaque from living humans just to assess
composition. Among the changes that have been documented include:
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Copyright 2006, Track Your Plaque.