Is Coronary Artery Disease Reversible?

Coronary artery disease (coronary artery blockage) is a frequent and severe health problem, being the most common cause of death in our country. There is, however, a bright side to this affliction. Taking care of yourself through diet, lifestyle modification and medications can definitely affect how well you do. While coronary artery disease (CAD) cannot be completely “cured”, we can often prevent or slow its progression.

Cholesterol lowering medications have been proven to have a significant lowering effect on CAD progression. In a study called the REVERSAL trial, patients who took a high dose of the cholesterol lowering medication, Lipitor, had an average of no disease progression as measured by intracoronary ultrasound. A recent, widely publicized trial from the Cleveland Clinic showed patients who received five weekly intravenous injections of a recombinant produced protein modified from one normally found in the body, resulted in a 4% decrease (reversal) in coronary artery cholesterol plaque (blockages) volume. This study was promising but very preliminary and the injections very costly. The HATS trial in which patients took a combination of Zocor and niacin resulted in a smaller but similar regression of coronary blockages over a three-year period. Niacin is one of the ways to increase HDL (the good cholesterol) in your bloodstream, along with lifestyle modification of smoking cessation and increased aerobic exercise.

The main benefit, however, of drugs and diet/lifestyle changes, is that they have been proven time and time again to significantly reduce heart attacks and mortality. This is probably due to mostly a change in the plaque composition rather than volume. Coronary blockages (plaque) consist basically of cholesterol (fats), fibrous tissue (scar) and inflammatory cells. It is the fatty inflamed plaque that ruptures and expands within the artery to occlude blood flow and cause heart attack and death. Cholesterol lowering (and other) medications reduce plaque fat content and inflammation to prevent this from occurring. We are therefore able to modify and stabilize these blockages which translates into a longer healthier life.

Written by Dr. Douglas Wunderly