With input from Dr Monica Vasudev

1342:

Is coronary artery disease regression possible?

1. Yes it is possible. It has been shown in studies; however, it is not easy.
2. It depends on lipid-rich plaques vs. calcified plaques. The TACT study, a chelation study, revealed that it is not possible to get rid of calcified plaque.
3. That is the origin of the term ‘hardening of the arteries’. However, lipid-rich plaque can be changed.
4. CT scan studies: When we do serial CT scans for coronary calcium, we lower the cholesterol. Since the calcium score is a density score, as the cholesterol is taken out, the calcium stays and the calcium density rises.
5. The Lower the Better for LDL-C. Certain PCSK9 inhibitor studies included substudies of ultrasound of the coronary arteries. In the studies, as the low-density lipoprotein cholesterol (LDL-C) lowered, there was more regression.
6. At about an LDL level of 80 mg/dL, nearly half of the individuals had regression of coronary artery disease. However, as the LDL got below 60 mg/dL, 90% of the regressable plaques or the lipid-rich plaques could regress.
7. To achieve regression, it is vital to remove causative agents, such as smoking, high blood pressure, high cholesterol, stress. The Lifestyle Heart Trial done over 2 decades back had suggested that stress plays a vital role in damaging the endothelium.
8. Reducing Inflammation Is Important: Coronary plaques cannot vanish. Though some obstructions will continue, the nature of the plaque is modified. A  study published in the Journal of the American College of Cardiologyrevealed that red meats, processed meats, ultra-processed foods, sugar-sweetened beverages, refined carbs, and processed carbs heightened inflammation. Fruits and vegetables, legumes, and whole grains decreased it.
9. Stress, lack of sleep, and lack of exercise are proinflammatory.
10. COVID-19, being inflammatory, can precipitate MI.

[Source: Medscape]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA