Is it possible to reverse atherosclerosis in the coronary arteries or anywhere else in the body? This topic, often called plaque regression, deserves an overview for anyone considering any Heart Health intervention.
Atherosclerosis – The Approach
It’s fair to say that if you are past your teenage years, you will have some atherosclerosis. This is the plaque buildup inside the arteries of the body which causes health problems mostly when it affects the blood supply to the heart, brain, and limbs.
1. Main Approach – Prevention
The main approach to atherosclerosis is preventing it.
With our Heart Health Coaching, the goal is to live a lifestyle that:
- decreases blood pressure
- lowers circulating apoB levels
- decreases inflammation
- improves mitochondrial health
For many, lifestyle changes are adequate, and we can track serum biomarkers such as lipid levels, inflammatory markers, and serum insulin levels to track success.
For others, chemical interventions may be necessary, even for the prevention stage, such as statins, ezetimibe, or the PCSK9 inhibitor class of medications.
2. Secondary Approach – Treatment
Some clients will already have an atherosclerosis diagnosis. Perhaps a physician noted it on a knee X-ray, or the patient is experiencing symptoms of angina.
The secondary approach is to help prevent major cardiovascular events (heart attack, strokes, peripheral vascular disease) due to the buildup of this plaque.
Must we reverse atherosclerosis for this secondary approach to be successful?
Plaque Regression
Western Medicine states that not all plaque is equal. We have stable plaque and potentially unstable plaque. Though this is a rough categorization, it’s a helpful mental model to follow.
The goal is to minimize unstable plaque but encourage remodeling of existing unstable plaque and perhaps to encourage plaque regression.
In plaque regression, the amount of plaque actually decreases. Tiny intravascular ultrasound (IVUS) or a CT angiogram (CCTA) can confirm this.
Available studies show that high-intensity statin therapy decreases overall plaque volume by 10%, but that may not fully explain the decreased risk of cardiovascular events. So, perhaps stabilization is just as important.
Stabilization vs. Regression
This summary article determines which is better, stabilization vs. regression of plaque. Of course, in real life, we don’t have to choose one or the other – that’s the headache best left for the researchers.
1. Stabilizing Plaque
MIRACL, PACT, CURE, HOPE, and Lyon support the idea that plaque stabilization is effective.
We know from various studies that a lower-fat diet, increased activity, and managing stress/sleep can stabilize plaque, shifting more toward the preferred calcified plaque.
It’s important to mention that statins tend to change plaque composition toward:
- fibrous volume
- calcified plaque
- reduction in fibrofatty volume
- decreased a necrotic core
2. Reversing Plaque
ASTEROID, REVERSAL, and SATURN studies, on the other hand, focused on plaque reversal as a way to decrease the risk of cardiovascular disease.
We haven’t come across any convincing studies to demonstrate that plaque regression is necessary to help prevent major cardiovascular events.
However, if plaque regression is the goal, high-dose statin treatment should be the treatment of choice.
This answers the common questions our clients ask us about whether to repeat CT angiograms or CACs.