Can You Reverse Coronary Artery Disease? - WebMD

If you have coronary artery disease (CAD), it means the arteries that supply blood to your heart muscle have plaque in their walls that may cause blockages. Getting those arteries to widen and become flexible again might seem daunting, but you're far from powerless.

You can absolutely prevent CAD from worsening, and with some hard work, you might even be able to reverse some of the damage, says Gregg Fonarow, MD. He's the co-director of the UCLA Preventative Cardiology Program at the David Geffen School of Medicine and a spokesperson for the American Heart Association.

CAD is the most common type of heart disease and the leading killer in the U.S. of both men and women. By taking action, you can reduce the chances of having a heart attack, which may happen if the plaque that's lining your arteries blocks blood flow to the heart.

To protect yourself, you'll need to stay on top of your diet and exercise and take your medications every day, says Fonarow. If your goal is to actually reverse CAD, those medications will likely include high-dose statins.

High-Dose Statins: Pros and Cons

Most people with CAD benefit from taking statins, drugs that lower levels of LDL "bad" cholesterol in your blood. Your doctor will likely recommend a specific statin and dosage based on your current LDL level and how much improvement is needed.

A "low-intensity" statin is designed to lower LDL by 30%. A "high-intensity" one should lower it by 50% or more.

There is very good evidence that high-intensity statins, also called high-dose statins, can reverse CAD, says Steven Nissen, MD, chair of cardiovascular medicine at the Cleveland Clinic. A landmark study led by Nissen 15 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.

"They had to get their LDL down to very low levels for us to see these results, around 60 mg/dL," or 60 milligrams per deciliter of blood, explains Nissen. (Normal LDL cholesterol is usually defined as anything lower than 100 mg/dL.)

Since then, other studies have shown similar results. "We know now that if your LDL cholesterol is lowered below 70 mg/dL, you can see a regression in the plaque by up to 24%," he says.

High-intensity statins aren't for everyone. About 3% of the time, people report side effects like headache and muscle soreness. Statins, especially when taken at high doses, have also been linked to a higher risk of type 2 diabetes.

Some people who want to stick with high-intensity statins but have muscle soreness find that this symptom relents if they switch to a different high-intensity statin or if they add a coenzyme Q10 supplement, says Nissen.

If you still can't tolerate high-dose statins, you might be able to reverse CAD by taking a lower-intensity statin along with a different type of cholesterol medication called a PCSK9 inhibitor. You get these medications as a shot every 2-4 weeks. Nissen and colleagues found that this combination caused plaque to decline in almost two-thirds of all patients. Those findings appeared in The Journal of the American Medical Association in 2016.

Even more drug options may be coming up. A medication called inclisiran, now in clinical trials, lowers cholesterol by preventing production of PCSK9 in the liver.

"It's been shown to significantly lower LDL levels, and with it, some of the plaque associated with coronary artery disease," Fonarow says. "It also may be easier for patients to stick to, because it's just a twice-a-year shot, unlike statins, which you have to take every day."

The Power of Lifestyle

Lifestyle changes alone likely aren't enough when you have coronary artery disease, but there's no doubt that they're a powerful addition to medication, Foranow says.

The American Heart Association recommends a diet that's rich in:

• Fruits and veggies
• Whole grains
• Low-fat dairy products
• Skinless poultry and fish
• Nuts and legumes
• Non-tropical vegetable oils like olive oil

You should also limit saturated fat, sodium, red meat, and sweets.

A nutrition plan created by Dean Ornish, MD, has been shown in small studies to lower cholesterol and reverse CAD. Ornish's diet requires you to follow a mainly plant-based eating plan that focuses on whole grains, fruits, vegetables, legumes, and soy products, with the option of nonfat dairy and egg whites. The plan is very low in fat, limiting fat to about 10% of your total calories. That can be very hard to stick to, says Fonarow. "We want to encourage people to make dietary changes that they'll be able to stick with long-term," he says.

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. There are many ways to manage stress, including exercise, keeping up close social ties, talking with a therapist, and meditation. Studies show that people who meditate regularly are about half as likely to get coronary artery disease as those who don't.

"Taken together, all these steps can help lower your risk of having a heart attack or stroke," Nissen says. "Our goal is to keep you alive and healthy," even if your coronary artery disease doesn't fully reverse.

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