How to Prevent or Reverse Heart Disease
Kristine L. Soly, MD, FACC
Until recently, coronary artery disease was thought to be incurable. The atherosclerotic plaque that narrowed the arteries nourishing the heart was considered to be permanent. This disease was expected to worsen until the vessel(s) eventually closed off. Those who did not die, lived a life of recurrent chest pain and disability despite drug therapy.
When Nathan Pritikin suggested in 1957 that the plaque could be reversed, the medical profession scoffed at him. To demonstrate that what he said was true, he used himself as a guinea pig. He had been diagnosed with coronary artery disease and told he would die if he did not assume a sedentary life. He rejected several doctors’ advice and decided he would change his lifestyle to get rid of the plaque in his coronary arteries. He followed a rigid diet (known as the Pritikin diet) and developed a moderate exercise program. As a result, he enjoyed years of robust good health. When he died many years later after he developed cancer, an autopsy showed that his coronary arteries were completely clear of plaque. The medical profession was unmoved. They still maintained that coronary heart disease could not be reversed. Pritikin’s case, they said, was a fluke.
This opinion went unchallenged until 1990, when Dr. Dean Ornish stated that Pritikin was right—coronary artery disease could be reversed—and set out to prove it. As a result of his excellent studies, it was shown that well-established plaque in coronary arteries could be reversed. He used lifestyle changes similar to those used by Pritikin. Dr. Ornish’s principles of diet, exercise, and stress reduction form the cornerstone of all the coronary regression programs in existence today. Now, no physician would deny that coronary artery disease can not only be reversed, but can even be prevented.
Cardiovascular disease begins in childhood and results from numerous risk factors including the food we eat, our sedentary lifestyle, the stresses we are exposed to, lack of support from family and friends, the habits we develop (like smoking), damages caused by free radicals in our polluted environment, as well as the genes that we inherit. In fact, the earliest manifestations of plaque are found in the arteries of 40% of one-year olds, and in 100% of two-year olds.
In these early stages, cardiovascular disease remains remarkably silent for many years. Although these early plaques are very unstable and frequently rupture, they usually rapidly heal and cause no symptoms. But they get larger each time they rupture and heal, and this narrows the arteries. Symptoms (like chest pain) do not usually develop until the artery is at least 75% narrowed. But prior to this, where there are no symptoms because the artery is not narrowed enough, heart attacks and sudden death can occur because plaque that ruptures can stimulate the formation of a blood clot that closes off the artery completely. In fact, this scenario accounts for 85% of all heart attacks and deaths.
Once someone has developed angina or has had a heart attack a plan must be developed to begin to reverse the disease. Unfortunately, it is not realistic to expect that everything can be returned to normal since some damage to the heart and other body organs cannot ever be repaired. Obviously, intervention before symptoms or damage have occurred is better. And prevention is the best of all approaches. But I have found that most people are not motivated to change until the wake-up call of angina, a heart attack or the sudden cardiac death of a friend or relative. The good news is that you can begin the process of reversing coronary heart disease at any time. However, I know from long experience with my patients that it requires determination and really hard work to bring about the significant lifestyle changes that will prevent or reverse the disease.
What’s worse, many people believe that the quick fix of an invasive procedure like angioplasty or bypass surgery are what you do when you find yourself in trouble with coronary heart disease. According to the American Heart Association, American doctors perform 1.5 million cardiac catheterizations each year, which result in over one million invasive cardiac procedures (coronary artery bypass, angioplasty, atherectomy, and stent insertion). These procedures cost over $50 billion and cause about 30,000 deaths a year.
The general presumption about these very serious invasive procedures is that they are necessary for survival and that they extend life. But on the contrary, what we have learned is that, with few exceptions, most of these invasive procedures are not required to save lives and do not extend the lives of those who have them. In fact, except for a small percentage of patients, medical management is identical to surgical management in alleviating cardiac symptoms, preventing heart attacks, and avoiding death. Furthermore, 80-95% of cardiac catheterizations are not indicated, and an equal percentage of coronary invasive procedures (bypasses, angioplasties, stents) are not necessary.
What is more important is that neither medical nor surgical therapy does anything to safely treat coronary heart disease to halt its inexorable progression. Lifestyle changes, as Pritikin and Ornish have shown, are the only way to successfully treat this disease and reverse its progress. This requires changing your diet, developing an exercise program you can stick with, learning to reduce stress, developing supportive intimate relationships with friends and family, and stopping all those bad habits you’ve developed like smoking.
These things are hard to do. But, if you do persevere and make these very difficult changes, do they really work? A fair question since it’s a lot easier for most people to take pills or even risk invasive procedures rather than change some of the things they really enjoy. A look at some of Dr. Ornish’s data gives us the answer.
His first study (The Lifestyle Heart Trial) was randomized, controlled clinical trial to assess the impact of comprehensive lifestyle changes on atherosclerosis. All patients underwent cardiac catheterization at the start of the study. They were then randomly assigned to conventional medical care or a lifestyle-change program of low fat vegetarian diet, smoking cessation, stress-management training (yoga), and moderate exercise. Within one month, blood pressure medication had to be reduced or stopped in the experimental group. Cardiac catheterization at one year showed regression of plaque in 81% of the lifestyle-change group compared to progression in 53% of the conventional group. Furthermore, without lipid-lowering medication, the experimental group had a drop in total cholesterol of more that 24% and in LDL (bad cholesterol) of more than 37%. Angina (chest pain) had decreased by 91% in the experimental group but had increased by 65% in the conventional group. Subsequent cardiac catheterization at five years revealed ongoing regression of plaque in the experimental group but further progression in the conventional group. Many subsequent regression trials have confirmed this data. No drugs or surgery can match these!
The battle against heart disease can be won by slowing or stopping the relentless progression of this disease. Drugs and surgery, with few exceptions, do not do this. They should only be used to buy time, and only when absolutely necessary. Coronary heart disease is preventable and reversible with lifestyle changes alone. The commitment of time and effort on the part of both the patient and health professional. But it’s the only way to make you truly “young at heart”!
Dr. Soly is board certified in Cardiology, Internal Medicine, and Holistic Medicine, and is a Fellow of the American College of Cardiology. She practices Holistic Cardiology and is director of the Holistic Cardiology Learning Center of Cape Cod at Sunflower Market Place, 923 Route 6A, Yarmouthport, MA 02675-2159, (508) 362-5925.