Recently I reviewed treatments from the scientific literature that have been used to promote the reversal of the #1 killer of men and women in the Western world, atherosclerotic cardiovascular disease (ASCVD). I have used all of these therapies in my preventive cardiology clinic, often in personalized combinations, and regularly demonstrate the exciting result of plaque reversal. The ability to demonstrate this reversal of arterial aging is limited to a few technologies of which only one is practical for daily use, quantitation with a carotid intimal medial thickness (CIMT) ultrasound. Here I will review some of these technologies and results from the literature and my clinic using pictures as they provide dramatic examples of a goal rarely discussed in medical training: disease reversal.
1) Coronary Angiography (Invasive and CT)
Coronary angiography using computer quantitation was used by Dean Ornish, MD and colleauges in the Lifestyle Heart Trial to demonstrate the reversal of plaque in heart arteries. After 5 years of lifestyle treatment, the patients following the program (open boxes) had a reduction in the amount of stenosis (narrowing) in their heart arteries while the control group got more clogged (black circles). The problem with this technique is that it is invasive, requiring a cardiac catheterization, and exposes the subject to risks that make it unacceptable for following patients in clinic.
Another way to use coronary angiography is to perform the invasive study without computer measurement which is less precise but more available. This was used on occasion by Caldwell Esselstyn, MD of the Cleveland Clinic Foundation and has provided some of the most dramatic images available in published articles. Dr. Esselstyn applied a whole food, plant diet without added oil to achieve these results.
Currently, angiography using CT imaging, rather than invasive catheterization, combined with computer quantitation, is being used in some trialsof plaque regression but this approach requires exposure to radiation and iodine based contrast agents (dye). Coronary artery calcium scoring (CACS) is a final CT based way to image heart arteries but also involves exposure to radiation so serial studies, every year for example, are not usually recommended to track plaque.
2) Carotid Intimal Medial Thickness (CIMT) Ultrasound
Ultrasound is a painless and quick manner of imaging arteries without X-ray exposure and the carotid arteries in the neck are ideal for imaging. Unlike heart arteries they are large, barely move, are straight, and are available just under the skin. Using a computer method called CIMT, quantitative measurements of plaque, and the potential for plaque reversal can be demonstrated. The test measures both the presence and the amount of plaque as well as the thickness of the inner two layers of the carotid artery (the intima and media) and measurements can be compared to large databases of healthy and age matched individuals. Because the CIMT uses ultrasound, it can be repeat over and over. There are hundreds of peer reviewed articles demonstrating the usefulness of the CIMT in many different populations of patients and members of the public. There are also articles using a baseline and follow-up CIMT to identify reversal of plaque after changes in diet and other measures. This is the technique I use on patients at my center with a program of lifestyle measures (emphasizing whole food plant diets) and supplements as previously described. Below are many images I had easy access to as visual examples of plaque reversal.
CIMT 1. An example of normal bilateral carotid arteries in a 59-year old physician (me).
CIMT 2. An example of a woman at age 38 with a CIMT of 60-year old that over 21 months of treatment in the clinic was reduced to an arterial age of 48
CIMT 3. A 64-year old woman with an arterial age of 55 (better than average) that was reduced to an arterial age of 48 over 2 years.
CIMT 4. An initially 66-year old man with an arterial age of 75 years old that was reduced to 61 years old over 7 months.
CIMT 5. An initially 62-year old female with mild bilateral carotid plaque shown at the top of her study. Her arterial age of 80 at the beginning of therapy was reduced to age 61 and the volume of the plaques was reduced also (not shown).
CIMT 6. A 59-year old man with an initial arterial age of 72 that was reduced to age 57 over the course of 30 months. Most of the change was in the last 19 months.
CIMT 7. An initially 71-year old male with an arterial age of 67 that was reduced to age 63 over 26 months
CIMT 8. A 53-year old woman with an initial arterial age of 63 that was reduced to age 51 over the course of 15 months of therapy.
Reversal of ASCVD has been demonstrated in peer reviewed and randomized studies using diet and lifestyle and is reimbursable in specialized programs offering intensive cardiac rehabilitation. Despite this, reversal of disease is rarely discussed or taught to trainees in medicine. The examples here, admittedly drawn from a random sample on my phone photo file and available from dozens of other patients I care for, provides hope and demonstration that early disease detection and reversal, is alive and well in cardiology and should be a goal more widely taught.