Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Reversal of Atherosclerosis and Reduction of Coronary Events by Lifestyle Alone

Dean Ornish was the first to show that lifestyle change alone was enough to reverse the development of atherosclerotic plaque and reduce plaque rupture the cause of acute coronary events. No drug or procedure has come close to this effectiveness. While Ornish’s diet was mostly vegetarian more liberal diets such as the St. Thomas Atheroma Regression diet or Southern Mediterranean type of diet are probably just as effective. Common to these diets is the reduction of saturated fat and meat and an increase in unrefined plant-derived foods. Ornish’s diet did not include addition or refiined omega-3 fatty acids but the other two did.

These studies are no priceless. They could not be done today. The cholesterol myth has such a powerful influence over the minds of doctors that it would be called unethical not to give statins to the people in those trials.

But what is really unethical is to perform further drug or procedure trials for treatment of atherosclerosis unless all subjects are using one of these lifestyles. To treat patients in clinical practice with drugs or procedures for atherosclerosis without insisting upon lifestye change first is just as unethical. But investigators are still doing it. See the recent report of the ASTEROID trial in which patients with major lifestyle problems were only given drugs for their atherosclerosis.

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The Lifestyle Heart Trial

Effect of lifestyle changes on coronary atherosclerosis: Lifestyle Heart Trial. In this secondary prevention study, individuals with documented coronary heart disease were either continued on a standard treatment protocol or were subjected to significant changes in lifestyle. These changes included a very low-fat vegetarian diet (<10% fat), weight reduction, smoking cessation, stress reduction, and moderate exercise. One hundred ninety-five coronary artery lesions were evaluated by quantitative coronary angiography before and after 1 year of either standard or lifestyle treatments. The data show that a significant alteration in lifestyle can induce a modest degree of regression of coronary atherosclerosis within 1 year.

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St. Thomas Atheroma Regression Study (STARS)

There was some reduction in LDL levels with this diet but the correlation of blood LDL with plaque reduction is poor. Total cardiovascular events were almost eliminated over 3 years. Addition of cholestyramine, a resin that sequesters cholesterol-containing bile acids in the gut made no significant difference.

It is instructive to compare STARS with the Lipid Research Clinics Coronary Primary Prevention Trial, a trial of cholestyramine superimposed on a “moderate cholesterol-lowering diet”. After 7.4 years of 1900 men taking 4 to 5 packets of resin per day coronary events were reduced by 1.5% and total mortality was not reduced.

Clinical events: STARS. In this secondary prevention study, the number of clinical events (death, nonfatal myocardial infarction, coronary artery bypass surgery or angioplasty during the trial, stroke, frequency and degree of angina, and change in anti-anginal medication) occurred considerably more frequently in the usual care group than in individuals on either diet alone or diet plus a bile acid resin. Thus, in addition to having beneficial effects on lipids and lipoproteins and coronary artery stenosis, therapy using diet alone, and especially with diet plus resin, was associated with a reduction in clinical events related to coronary heart disease. These observations suggest that the therapeutic interventions resulted in stabilization of the coronary artery atherosclerotic lesions.

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Mediterranean Diet

In this landmark study a mediterranean diet after a heart attack markedly reduced the rate of recurrent heart attack and significantly prolonged life with no change in blood cholesterol, probably due to a reductiion in modified LDL in the vascular wall.

One Response to “Reversal of Atherosclerosis and Reduction of Coronary Events by Lifestyle Alone”

  1. Rebecca Hoover said

    Good posts! Informative and helpful. I wish you didn’t use the monthly picture, however. I think individuals from low-income families often miss out on early education related to nutrition and life style factors such as smoking, and then they end up in poor condition. Later, when these individuals become ideal candidates for roles as subjects in trials, they are used again. Many individuals from low-income families lead miserable lives.

    I think we need to read our policy makers the riot act on not ensuring that health education is available in all schools. I think we also need to ensure all kids have access to healthy food so they get the start in life that leads to higher IQs and later good health. Finally, we need community education on nutrition.

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