Many patients ask if their heart blockages can be reversed through diet, lowering LDL (diet and/or medications) or other risk factors. For example, the Ornish Diet Program claims it will lead to ‘heart disease reversal’.
The answer to this question is: ‘mostly no…sometimes yes.’
Our overall goal in preventive cardiology is not really to ‘reverse’ heart disease (regress a heart blockage’). Rather, we are looking to ‘heal’ or ‘stabilize’ coronary artery disease. By aggressively lowering our risk factors, we can reduce the incidence of myocardial infarction and cardiac death, through cholesterol plaque stabilization, even though there is no actual regression of the blockage. It is this ‘healing’ or ‘stabilization’ of the plaque which translates into fewer cardiac events.
It is critical that you know the difference between plaque regression and plaque stabilization.
Medical Terms You Need to be Familiar With:
Artery = blood vessel
Coronary = heart
Reversal = regression: refers to shrinking of a blockage.
Heart catheterization = heart cath = cath = angiogram: refers to an invasive evaluation of your heart arteries.
A coronary artery plaque is a cholesterol build up within your heart (any) blood vessel (artery). Think of a blister of cholesterol under the inner lining of your heart blood vessel. Over time, this cholesterol plaque becomes hardened or calcified. This is the basis of the calcium score.
Plaque Healing = Plaque Stabilization ≠ Plaque Regression
The healing or stabilization of a blockage does not imply that the blockage shrinks. In fact, there may be no decrease in the severity of the blockage yet the incidence of heart disease is significantly reduced if the blockage is stabilized.
Of course, we want to reverse or regress blockages if we can. Yet, the majority of blockages are too well established to be reversed by lowering risk factors.
Can Plaques Regress/Reverse?
Yes. Certain cholesterol plaques that are non-calcified, the that younger patients may have, may be reversed by aggressive risk factor suppression.
For example, If LDL is aggressively lowered, soft plaque (heart blockages) may regress (shrink). It doesn’t matter how you lower the LDL: medications, diet or both. Just get it your LDL, along with your blood pressure, HgbA1c, weight, etc.
How do I know this? Because I spent much of my career as an interventional cardiologist. Having performed thousands heart catheterizations and stent procedures, I have seen plaque regression firsthand in a small number of patients with extremely low LDL. Plaque regression does occur. Heart disease reversal does occur.
Yet despite knowing that it may be possible to regress a cholesterol plaque in a younger patient (will not occur in calcified plaque of older patients) I have never promised any patient, no matter what age, no matter how low I suppress their risk factors, that we can regress their CAD. Once again, this is because it is not plaque reversal/regression that is our goal, it’s plaque stabilization.
Cardiologists believe that it is this stabilization of the coronary artery plaque which reduces the likelihood of plaque rupture.
In fact, it is this rupture/healing cycle which may be the basis of plaque progression.
Heart Disease Reversal? Plaque Stabilization?
So if the emphasis is plaque healing or stabilization and not reversal, why does the Ornish Diet program use the term ‘heart disease reversal’?
Because would you rather attend a program that promises ‘heart disease reversal’ or ‘plaque stabilization?’
In summary:
The focus should NOT be only on plaque regression. Rather we should emphasize plaque ‘stabilization’ or ‘healing.’
Patients in their mid 60s, 70s and older often have calcified plaque which cannot regress. In fact, the presence of calcium is the basis of the age-old ‘calcium score’.
By lowering LDL with statin and diet, can reduce risk of an MI by stabilizing the cholesterol plaque.
Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.
Stay Healthy!
Gregg Yamada MD FACC
Disclaimer: I hope you find my medical blogs to be pertinent, interesting, and thought provoking. The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.
© 2022. Gregg M. Yamada, MD FACC. All rights reserved.