Reversing Heart Disease
- Atherosclerosis regression has been demonstrated clearly in animal experimental models and, to a lesser extent, in humans.1 Imaging techniques for study of the arterial wall are playing a key role in promoting our appreciation of regression.
- Reversal of heart disease requires achieving and maintaining LDL-C (low density lipoprotein cholesterol) <70mg/dl and non-HDL cholesterol <100mg/dl and increasing the HDL by >8% along with a systolic blood pressure of <110 mmHg. It takes several years of aggressive treatment for reversal of heart disease to occur.2, 3
- Potent statins and effective blood pressure medications are now available to lower the LDL and blood pressure respectively. Clinical trials evaluating the broad spectrum benefits of prescription niacin in raising the HDL and other benefits are currently underway.
- Prolonged statins therapy with potent statins at high doses reduces heart attacks and not only slows the progression of coronary atherosclerosis but also reverses it in proportion to achieved reduction in LDL cholesterol. For instance, after 104 weeks of therapy, the rosuvastatin group (40 mg/d) had lower levels of LDL cholesterol (63 vs. 70 mg/dl and greater regression (69% vs 63%) than the atorvastatin group (80 mg/d).4 Achieving regression of atherosclerosis is possible but difficult and often unnecessary to avoid heart attack and/or live longer.4
1. Lee J M, Choudhury RP. Atherosclerosis regression and high-density lipoproteins. Expert Rev Cardiovasc Ther. Sep 2010;8(9):1325-1334.
2. Howard BV, Roman MJ, Devereux RB, et al. Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial. Jama. Apr 9 2008;299(14):1678-1689.
3. Nicholls S J, Tuzcu EM, Sipahi I, et al. Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. Jama. Feb 7 2007;297(5):499-508.
4. SJ. N, Ballantyne CM, Barter PJ, et al. Effect of Two Intensive Statin Regimens on Progression of Coronary Disease. N Engl J Med. Nov 15 2011.