***This article was first published in the New York Times by Richard Klasco, M.D. 

 

Q. Is it possible to remove plaques in your aorta or reduce their size through changes in diet or lifestyle?

A. Yes, lifestyle changes, including diet, smoking cessation, stress management and exercise, can decrease the size of atherosclerotic plaques. They can also help to stabilize them so that they are less likely to break off and block blood flow, decreasing your risk of a heart attack.

The notion of plaque reduction, known medically as regression of atherosclerosis, arose from a fortuitous observation during World War II. Norwegian scientists noticed that the scarcity of food — particularly the scarcity of high-fat foods like milk, cream, butter and cheese — was associated with a decreased risk of death from heart disease. This suggested the possibility that dietary changes could induce plaque regression.

The first direct evidence of regression came in 1947. In performing autopsies on malnourished patients, an astute pathologist noted that plaques “usually, but not invariably, tend to undergo resorption.”

But proof of regression in living patients would not come for another 40 years. In 1987, a study of diet and cholesterol-lowering drugs proved for the first time that regression was possible in humans. Three years later, the groundbreaking Lifestyle Heart Trial extended these findings by demonstrating that lifestyle changes alone, without cholesterol-lowering medications, could bring about regression, even in severely atherosclerotic arteries.

Adhering to the required lifestyle changes, however, was challenging. The diet was a whole food, vegetarian diet that restricted fat to no more than 10 percent of total calories. In addition, the subjects had to quit smoking, perform regular aerobic exercise and participate in group therapy stress reduction sessions.

The Lifestyle Heart Trial, however, was small, involving only 28 men. But its findings were soon confirmed by larger studies, including a 2015 meta-analysis that combined data from all previously published trials and assessed the value of lifestyle modifications on more than 2,000 arterial plaques. The data provided conclusive proof that lifestyle modifications, albeit intensive ones, can decrease plaque.

Despite their proven benefits, diet and lifestyle modifications must be viewed as adjuncts to, rather than substitutes for, medication for many patients. Regression of atherosclerosis is maximized when all three are used together. While changing established habits requires a high degree of motivation, the promise of shrinking plaque and lessening one’s risk for heart attack should be quite motivating.

Primary Care & Hospitalist