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Whole Food Plant-Based Diet and Blockage Reversal

In 1995, Caldwell Esselstyn from Cleveland, America, published the results of a groundbreaking study showcasing the power of a whole food plant-based diet in reversing blockages. The study revealed significant angiographic reversal of blockages through diet control alone. This evidence was reinforced in a larger trial of 198 patients in 2014, where intensive counselling led to a dietary compliance rate of 87%

Before

After

(Coronary angiography reveals a diseased distal left anterior descending artery (Before). Following 32 months of a plant based nutritional intervention without cholesterol-lowering medication, the artery regained its normal configuration (After).

1. Esselstyn CB Jr, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract. 1995 Dec;41(6):560-8. PMID: 7500065.

2. Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b. PMID: 25198208.

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Lifestyle Changes and Blockage Reversal

Dean Ornish from California, America, published his findings in 1998 on the impact of intensive lifestyle changes in reversing coronary heart disease. This randomized controlled trial involved 48 patients who underwent an intervention consisting of a vegetarian diet, exercise, stress management training, smoking cessation, and group psychosocial support for five years. The results showed notable blockage reversal in the intervention group, with greater reversal observed after five years compared to one year. Conversely, the control group experienced blockage progression and a higher incidence of heart attacks during follow-up.

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Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. doi: 10.1001/jama.280.23.2001. Erratum in: JAMA 1999 Apr 21;281(15):1380. PMID: 9863851.

Statin Drugs and Blockage Reversal

The REVERSAL trial was the first to demonstrate the halting of blockage progression with high-dose Atorvastatin. The intervention arm achieved an average LDL level of 79 mg/dL. Subsequent trials, including ASTEROID, SATURN, and PRECISE IVUS, collectively enrolled over 1500 patients. These studies demonstrated blockage reversal using either Rosuvastatin 40 mg or Atorvastatin 80 mg, achieving LDL levels of 63 mg/dL in the intervention groups

Chhatriwalla AK, Nicholls SJ, Nissen SE. The ASTEROID trial: coronary plaqueregression with high-dose statin therapy. Future Cardiol. 2006 Nov;2(6):651-4. doi:10.2217/14796678.2.6.651. PMID: 19804256.
Nicholls SJ, Ballantyne CM, Barter PJ, Chapman MJ, Erbel RM, Libby P, Raichlen JS, Uno K, Borgman M, Wolski K, Nissen SE. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med. 2011 Dec 1;365(22):2078-87. doi: 10.1056/NEJMoa1110874. Epub 2011 Nov 15. PMID: 22085316.

Nicholls SJ, Ballantyne CM, Barter PJ, Chapman MJ, Erbel RM, Libby P, Raichlen JS, Uno K, Borgman M, Wolski K, Nissen SE. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med. 2011 Dec 1;365(22):2078-87. doi: 10.1056/NEJMoa1110874. Epub 2011 Nov 15. PMID: 22085316.

Tsujita K, Sugiyama S, Sumida H, Shimomura H, Yamashita T, Yamanaga K, Komura N, Sakamoto K, Oka H, Nakao K, Nakamura S, Ishihara M, Matsui K, Sakaino N, Nakamura N, Yamamoto N, Koide S, Matsumura T, Fujimoto K, Tsunoda R, Morikami Y, Matsuyama K, Oshima S, Kaikita K, Hokimoto S, Ogawa H; PRECISE–IVUS Investigators. Impact of Dual Lipid-Lowering Strategy with Ezetimibe and Atorvastatin on Coronary Plaque Regression in Patients With Percutaneous Coronary Intervention: The Multicenter Randomized Controlled PRECISE-IVUS Trial. J Am Coll Cardiol. 2015 Aug 4;66(5):495-507. doi: 10.1016/j.jacc.2015.05.065. PMID: 26227186.

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PCSK9 Monoclonal Antibodies Injections and Blockage Reversal

PCSK9 inhibitors are potent injections capable of lowering LDL levels by 80% to 85%. The GLAGOV, HUYGENS, and PACMAN AMI randomized trials collectively enrolled 1500 patients. These trials demonstrated significant blockage reversal, as assessed by plaque area volume regression in the intervention arms. The LDL levels were impressively reduced to between 23 and 36 mg/dL.

Nicholls SJ, Puri R, Anderson T, Ballantyne CM, Cho L, Kastelein JJ, Koenig W, Somaratne R, Kassahun H, Yang J, Wasserman SM, Scott R, Ungi I, Podolec J, Ophuis AO, Cornel JH, Borgman M, Brennan DM, Nissen SE. Effect of Evolocumab on Progression of Coronary Disease in Statin-Treated Patients: The GLAGOV Randomized Clinical Trial. JAMA. 2016 Dec 13;316(22):2373-2384. doi: 10.1001/jama.2016.16951. PMID: 27846344.

Nicholls SJ, Nissen SE, Prati F, Windecker S, Kataoka Y, Puri R, Hucko T, Kassahun H, Liao J, Somaratne R, Butters J, Di Giovanni G, Jones S, Psaltis PJ. Assessing the impact of PCSK9 inhibition on coronary plaque phenotype with optical coherence tomography: rationale and design of the randomized, placebo-controlled HUYGENS study. Cardiovasc Diagn Ther. 2021 Feb;11(1):120-129. doi: 10.21037/cdt-20-684. PMID: 33708484; PMCID: PMC7944215.

Räber L, Ueki Y, Otsuka T, Losdat S, Häner JD, Lonborg J, Fahrni G, Iglesias JF, van Geuns RJ, Ondracek AS, Radu Juul Jensen MD, Zanchin C, Stortecky S, Spirk D, Siontis GCM, Saleh L, Matter CM, Daemen J, Mach F, Heg D, Windecker S, Engstrøm T, Lang IM, Koskinas KC; PACMAN-AMI collaborators. Effect of Alirocumab Added to High-Intensity Statin Therapy on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction: The PACMAN-AMI Randomized Clinical Trial. JAMA. 2022 May 10;327(18):1771-1781. doi: 10.1001/jama.2022.5218. PMID: 35368058; PMCID: PMC8978048.

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