Is coronary artery disease regression possible?
Dr K K Aggarwal
President CMAAO, HCFI,
With input from Dr Monica Vasudev
1st Feb
Is coronary artery disease regression possible?
1. Yes. It’s been shown in studies, but it’s not easy to do.
2. Depends on Lipid-rich plaques vs calcified plaques. The TACT study, which we were a part of at Mayo, was a chelation study and showed that we really cannot get rid of [calcified plaque] once it is there.
3. That is where the term "hardening of the arteries" comes from. But the lipid-rich plaque can be changed.
4. CT scan studies: serial CT scans for coronary calcium, lower the cholesterol, and because the calcium score is a density score, as you take the cholesterol out, the calcium stays and the calcium density goes up.
5. The Lower the Better for LDL-C. Some of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor studies included substudies of ultrasound of the coronary arteries. They showed that as we lowered low-density lipoprotein cholesterol (LDL-C), we got more regression.
6. At about an LDL of 80 mg/dL, with everything else being equal, about half of the subjects had coronary artery disease regression. But as you got the LDL below 60 mg/dL, 90% of the regressable plaques or the lipid-rich plaques could show a regression.
7. To get regression, another area is to remove causative agents: Smoking, high blood pressure, high cholesterol, stress. The Lifestyle Heart Trial done over 20 years ago by Dean Ornish demonstrated that. Stress plays a huge role in damaging our endothelium.
8. Reducing Inflammation Is Key: Coronary plaques cannot disappear. Some obstructions will continue, but the nature of the plaque changes, which is important for the patient. A recent study in Journal of the American College of Cardiology showed Red meats, processed meats, ultra-processed foods, sugar-sweetened beverages, refined carbs, and processed carbs all increased inflammation. The foods that decreased it were fruits and vegetables, legumes, and whole grains.
9. Stress, lack of sleep, and lack of exercise, are proinflammatory, also play a role.
10. COVID 19 being inflammatory can precipitate MI.
