PEAK TESTOSTERONE

Yes, Regressing Plaque Reduces Heart Attacks and Angina!

I've been having an interesting conversation with a knowledgeable poster on The Peak Testosterone Forum who stated that doubt as to whether regressing plaque would result in any significant reduction in heart attack risk. Basically, he felt that plaque regression was a secondary or bit player in cardiovascular outcomes.  This left me utterly in shock, because there is a large amount of evidence that reducing plaque reduces cardiovascular risk.  It also left me a bit angry with all the Paleo and Low Carb bloggers out there who make light of arterial plaque, LDL particle counts and so on. 

The reality is that most of these bloggers know that LDL-P and arterial plaque matter.  Furthermore, they also know that the majority of men with high cholesterol and high regular LDL will also have high LDL-P.  Yet they leave out those key details from their unsuspecting readers in almost every case, leaving them more vulnerable to developing heart disease.

 And all of this is why I will list the Evidences that Reducing Plaque Reduces Heart Attacks and Angina:  

NOTE:  Angina is the excruciating heart pain that many men with advanced heart disease experience.

1.  Statins And It's a Friggin Miracle.  I am no fan of statins and I think that I have an excellent warning page on the subject:   The Potential Dangers of Statins. Yet, in spite of all their issues, I don't know of any expert who does not believe that they generally improve heart disease outcomes. And, if you stop and think about it, it is miraculous that statins worked as well as they do considering that no lifestyle changes are usually mandated in the research. In fact, it is truly surprising that anything would regress plaque and improve heart attack rates if a Western Diet was consumed!

But the fact remains that statins can not only regress plaque, but they also reduce significantly the risk of heart attacks and angina.  There are at least a half dozen studies that show that statins can do all of these, but let me cite a interesting example below:

The ACAPS Study.  Lovastatin was found to result in the following:

"In men and women with moderately elevated LDL cholesterol, lovastatin reverses progression of IMT in the carotid arteries and appears to reduce the risk of major cardiovascular events and mortality." [2]

IMT is an ultrasound of the carotid neck artery and is commonly used in cardiovascular studies to monitor plaque, because it is lower cost and non-invasive.

The POSCH study is another one that shows similar results.  And, again, there are several dozen studies that show improved heart outcomes with statins and ins some cases even reversal of atherosclerosis.  Furthermore, it is well-accepted by just about everyone:  statins reduce the relative risk of a heart attack by about 15-30%

Is a 15-30% risk reduction worth the risk of side effects?  I'll leave that up to you and your situation, but my point here is that statins work and they often regress plaque while they are at it.  No, they're not perfect due to their side effect profile, but they do clearly show that one can regress plaque and decrease MI risk at the same time.

2. Diet + Statins.  The next logical question  is the following:

"What would happen if you combined both statins and anti-plaque dietary and lifestyle modifcations at the same time?"

This is exactly what Dr. K. Lance Gould did in his clinical practice and his results are stellar. Basically Dr. Gould believes in a Low Carb, Low Fat Diet.  He attempts with this type of diet to bridge the gap between the low carb and low fat folks by limiting both carbs and fat thus getting the best of both worlds.  As an fyi, his diet is low medium carb and not a true ketogenic diet.  However, he significantly limits carbs by insisting that you consume fruit, low fat meats and dairy to displace grains.  You can have some grains, but it needs to be quite limited. 

Now, for those of you, concerned about fruit, remember that fructose, interestingly enough, does not cause much of a spike in insulin.  And keeping control of one's insulin is the key in keeping yourself from going into a pattern B lipid profile.  He also wants you to eat lean proteins and non-fat dairy so that they extra protein will displace more carbs.  This is nice for men doing weight lifting or strength training as they want to consume a solid amount of protein anyway.

So what kind of results do you achieve by eating Low Fat, Low Carb + a Statin?  The results are very impressive: to say the least:

"1.  Reverses or stops progression of disease in over 90% of people.

2.  Decrease incidence of heart attacks, balloon dilation, bypass surgery by 90%.

3.  Improves coronary blood flow by PET.

4.  Relieves angina, increasess activity level, energy, sense of well-being.

5.  Treats diffuse disease, throughout length of arteries.

6.  Heals endothelium lining of arteries.

7.  Serves as valid alternative or supplementation to balloon dilation, bypass surgery." [7]

3.  Lifestyle Only.  Of course, most men reading this probably do not want anything to do with statins.  We all know they have lots of side effects and can increase the risk of muscle damage and diabetes - the cure can be worse at times than the disease, eh?  This is why a couple of researchers stepped in and looked at solutions with no statins and only lifestyle changes.  Here are the two most famous:

a. Esselstyn.  Dr. Caldwell Esselstyn advocates a largely vegan, low fat, whole foods diet.  My understanding is that he pushes the vegan aspect because plants do much a great job of boosting nitric oxide and nitric oxide is nature's anti-inflammatory.  Of course, I agree with him in the sense that consuming a lot of plant foods boost nitric oxide, and this was a large part of my book:  The Peak Erectile Strength Diet.

And it's hard to argue with Dr. Esselstyn as he also achieved excellent results, some of which he tracked long term:

"In contrast, a 5-year experience has shown excellent results in patients with severe coronary artery disease who followed a plant-based diet containing <10% fat and who took cholesterol-lowering medication.  During this arrest and reversal therapy their lipid levels fell significantly, they experienced no new coronary events, and angiography showed that their disease had stabilized and in some cases selectively reversed. The goal at study onset in 1985 had been to achieve a total serum cholesterol of <150 mg/dl, the level seen in cultures where coronary artery disease is virtually absent." [6]

He also followed up his own patients who were generally placed only on a low fat plant-based diet and, again, noted excellent results among these patients.  See reference #6 for details.

b. Ornish.  Dean Ornish low fat diet study is arguably the most famous in this lifestyle-only category.  His study participants made not just dietary changes but also engaged in stress management, moderate exercise, smoking cessation and social interactions.  His results were also excellent:

"The average percentage diameter stenosis regressed from 40 0 (SD 16 9)% to 37 8 (16 5)% in the experimental group yet progressed from 42 7 (15 5)% to 46 1 (18 5)% in the control group. When only lesions greater than 50% stenosed were analysed, the average percentage diameter stenosis regressed from 61 1 (8 8)% to 55 8 (11 0)% in the experimental group and progressed from 61 7 (9 5)% to 64 4 (16 3)% in the control group. Overall, 82% of experimental-group patients had an average change towards regression." [3]

Esssentially, 5/6ths of the particpants regressed plaque.  Furthermore, this same study logged a 90% reduction in angina rates after one year!  And, perhaps best of all, plaque regression continued to improve for up to five years!

CONCLUSION:  There are many ways to regress plaque pharmaceutically or with lifestyle changes or both.

REFERENCES:

1)   J Am Coll Cardiol. 2004 Jun 2;43(11):2142-6. Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal.

22) Circulation, 1994 Oct, 90(4):1679-87, "Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group"

3) The Lancet, 21 July 1990, 336(8708):129 133, "Can lifestyle changes reverse coronary heart disease?"

4) JAMA, Dec 16 1998, 280(23), "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease"

5) Lancet, 1994 Nov 19, 344(8934):1383-9, "Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)"

6) http://www.dresselstyn.com/reversal01.htm

7) Heal Your Heart, Dr. K Lance Gould, p. 194