Mr A, 68 years, a follow-up patient for 10 years recently started to have frequent episodes of angina. A known diabetic and hypertensive since 15 years, he had a heart attack and Dr Sameer Kubba, Director, Clinical & Interventional Cardiology, Max Super Specialty Hospital, Vaishali performed stenting in two of his coronary arteries. Patient was doing well and had been very diligent in following a heart healthy lifestyle besides taking his cardiac medications religiously. Despite controlling all modifiable risk factors, Patient had progression of atherosclerotic cardiovascular disease which was disheartening. We implanted another stent and optimised with medications.
Atherosclerosis, the hardening of the arteries due to the build-up of cholesterol-rich plaques in the walls of arteries, is the primary cause of heart attacks and strokes, which together account for more than half of all deaths worldwide. Scientists have been searching for ways to prevent early-stage atherosclerosis from progressing to the more dangerous, advanced stage to improve outcomes of patients at risk of coronary artery disease (CAD). The good news is there is data to suggest that early-stage atherosclerosis can regress significantly and even completely in some situations. Later-stage atherosclerosis is relatively resistant to reversal though its progression can be delayed.
This suggests that individuals at increased CAD risk would benefit greatly from early prevention using diet and lifestyle measures and use of cholesterol-lowering drugs like statins. Even healthy people at increased risk for CAD are likely to benefit from statin therapies even if their LDL cholesterol levels are only mildly elevated. Prescribing statin therapy to people with early blockages might be more effective to delay the progression or at times reverse atherosclerosis than administrating these drugs to patients with more advanced forms of arterial plaques. In mice with early-stage atherosclerosis, a gene was found to be involved in causing the complete regression. In mature and advanced cases, different genes in the network have been identified in research studies which have proved to be influential in controlling the regression of atherosclerosis. However as of now reversal of the disease is usually not possible except in very early stages but the progression of the disease can definitely be slowed down by following evidence based guidelines on diet, lifestyle and use of appropriate medications. A landmark study 16 years ago called the ASTEROID trial found that patients who took a very strong statin daily for 2 years were able to reverse plaque buildup and thickening of their arteries.
Lifestyle changes alone likely aren’t enough when CAD has developed, but there’s no doubt that they’re a powerful addition to medication. A diet that is rich in fruits, vegetables, whole grains, low fat dairy products, nuts, legumes, soy products with an option of non fat dairy and egg whites has been shown lower cholesterol and reverse CAD to some extent in some small studies. This diet plan is low in fat, limiting fat to about 10% of the total calories which can be hard to stick to in the long run.
Other parts of a healthy lifestyle won’t necessarily reverse coronary artery disease but may prevent it from getting worse. These include:
Regular exercise . Regular physical activity helps repair some of the damage in the endothelium, the thin membrane that lines the inside of blood vessels. This, in turn, allows more blood to pump through your vessels.
- Not smoking. Cigarette smoke causes the platelets in your blood to become stickier and clump together, which can lead to a blood clot that can cause a heart attack.
- Stress management . If you’re too stressed for too long, it can be a problem. Chronic high levels of stress hormones such as cortisol raise blood cholesterol and also cause changes that promote the buildup of plaque in your arteries.
The American Heart Association strongly advocates Life’s Essential 8 as key measures to improve and maintain cardiovascular health. These essential 8 comprise two major areas: Health Behaviour and Health Factors. Eating better, being more active, quitting tobacco and getting healthy sleep are the 4 health behaviour essentials while managing weight, blood sugar, blood pressure and controlling cholesterol are the 4 health factor essentials.
With ageing and the passage of time, there would be progression of the atherosclerotic process which becomes more resistant to reversal.
Taken together, these steps can lower the risk of development of a heart attack and progression of disease. The goal is to keep you alive and healthy, even if your coronary artery disease doesn’t fully reverse.
For More information, please visit: https://www.linkedin.com/mwlite/profile/in/samir-kubba-59648b50
The author of this article is Dr Sameer Kubba, Director, Clinical & Interventional Cardiology, Max Super Specialty Hospital, Vaishali. This initiative is undertaken in the public interest. The Information is only suggestive for patient education and shall not be considered as a substitute for a doctor’s advice or recommendations. Please consult your doctor for more information.
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