Vigorous non-invasive treatment (diet, drugs, exercise etc) has been shown to interrupt, or even reverse, coronary artery disease, and thus prevent myocardial infarction (MI) and sudden death. Dr Lance Gould, a recognized expert, has summarized the scientific evidence showing how this is possible in an on-line conference ¹ .

Over half the cases of heart attacks or sudden death occur in people with coronary disease who don't have warning symptoms sufficient to take them to the doctor. In these patients, rupture or thrombosis of a relatively small, lipid-rich plaque, or patch, on the artery wall, is the immediate cause.

The small plaques produce changes in the microscopic circulation to the heart muscle, which can be visualized using a non-invasive technique called positron emission tomography (PET). These changes can be seen earlier than the degrees of artery closing found using coronary arteriography in the cath lab.

Both drugs and diet have been shown in large-scale clinical trials to reduce serum lipid levels, myocardial infarction (MI), sudden death and overall mortality. Some studies have used arteriography to show improvements in the degree of closure of coronary arteries, and others a reduction in the need for bypass surgery or coronary angioplasty operations. Dr Gould, however, emphasizes that a reduction in the coronary disease process depends more on control of the rise in serum lipids after a meal than on the "resting" or fasting LDL cholesterol level. Moreover, the rise in lipids after eating is most predictive of impaired heart muscle micro-circulation. Therefore, a reduction in the lipid response to a meal, which can be shown on PET imaging, corresponds more closely to a reduced risk of coronary heart disease than do other measurements.

The lipid elevation after a meal cannot be completely controlled by the commonly used "statin" drugs given alone, but the addition of other drugs (e.g. long-acting niacin, gemfibrazole) or adhering to a very low-fat diet can produce this reversal. (In a very low-fat diet, fat is kept to less than 10% of the total calories.)

Are revascularization procedures, such as bypass surgery or coronary angioplasty, better than vigorous medical management? Dr Gould doesn't think so. After comparing the results of various studies, he concludes that, in the long term, surgical procedures do not improve, and may in fact worsen, the outcome, whereas cholesterol-lowering treatment can dramatically reduce MI and mortality over the years. The reason he gives is that revascularization does not alter the basic disease process, in contrast to medical management, which changes the conditions required to continue progression of the disease.

Dr Gould believes that non-invasive treatment ("statins" and other drugs, very low-fat diets) and non-invasive monitoring (PET imaging) can effectively replace invasive diagnosis (cath lab arteriograms) and surgery (bypass or angioplasty). The end results are similar or better, and the actual health-care costs are correspondingly lower - by about 35%.

Source

The virtues of reversal treatment for coronary atherosclerosis
KL. Gould, From Online Cyberounds: Cardiovascular, February, 1997, vol. , pp. --

Footnotes

1.

The virtues of reversal treatment for coronary atherosclerosis.
LK. Gould, Online Cyberounds: Cardiovascular February., 1997