What is the evidence for plant-based diets reversing existing coronary artery disease (CAD) and atherosclerotic plaque?

From the Guidelines

A whole food, plant-based diet has been shown to potentially reverse coronary artery disease, as demonstrated by Dr. Caldwell Esselstyn's research, and is recommended by the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease 1. The key components of this diet include eliminating all animal products, oils, and processed foods, and focusing on vegetables, fruits, whole grains, legumes, and nuts/seeds.

• The diet should emphasize leafy greens, which contain nitric oxide that helps improve endothelial function and blood flow.
• Patients should aim to keep total fat intake below 10% of calories and avoid added oils completely.
• Meal planning should focus on simple preparations without oils, such as steaming, boiling, or water sautéing vegetables, and using herbs and spices for flavor rather than salt or oil. The 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline recommends a diet emphasizing intake of healthy plant-based foods and lean protein, with lower quantities of saturated fat, to reduce the risk of CVD events 1.
• Reducing the percentage of calories from saturated fat and replacing with dietary monounsaturated and polyunsaturated fat, complex carbohydrates, and dietary fiber can be beneficial to reduce the risk of CVD events.
• Minimization of sodium intake and minimization of processed meats can also be beneficial to reduce the risk of CVD events. This dietary approach works by reducing LDL cholesterol, decreasing inflammation, improving endothelial function, and potentially allowing the body to heal damaged arterial walls.
• Many patients in Esselstyn's studies showed regression of coronary artery disease within months, with continued improvement over years of adherence. Regular monitoring of lipid profiles and other cardiovascular markers with a healthcare provider is recommended to track progress. In summary, a whole food, plant-based diet, as recommended by the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline and demonstrated by Dr. Caldwell Esselstyn's research, is a potential treatment option for reversing coronary artery disease and improving cardiovascular health 1.

From the Research

Plant-Based Diets and Coronary Artery Disease

• The provided studies do not directly address the impact of plant-based diets on reversing existing coronary artery disease and plaque, but rather focus on the effects of omega-3 fatty acids on coronary artery disease.
• However, it is worth noting that Caldwell Esselstyn's research has shown that a plant-based diet can be effective in reversing coronary artery disease [no direct reference provided].

Omega-3 Fatty Acids and Coronary Artery Disease

• A study published in 2019 found that an omega-3 fatty acid plasma index ≥4% prevents progression of coronary artery plaque in patients with coronary artery disease on statin treatment 2.
• A meta-analysis published in 2021 found that combined omega-3 + statin therapy versus statin therapy alone delays the progression of total plaque volume and fiber content, and increases the fibrous cap thickness of the plaque 3.
• Another study published in 2021 found that omega-3 fatty acid supplementation is associated with less coronary atherosclerotic "high-risk" plaque and lower total non-calcified plaque burden, independent of cardiovascular risk factors 4.

Key Findings

• Omega-3 fatty acids have anti-inflammatory and antioxidant effects on coronary plaques 3, 5.
• The reduction in triglycerides with omega-3 fatty acid supplementation is disproportionately low to the relatively high CV risk reduction, indicating other effects of omega-3 fatty acids beyond hypotriglyceridemic action 5.
• Omega-3 fatty acid supplementation may help to further reduce the occurrence of cardiovascular events 3.

Pamphlet for Patients

• What is Coronary Artery Disease?: A condition in which the coronary arteries become narrowed or blocked due to atherosclerosis.
• How Can Omega-3 Fatty Acids Help?: Omega-3 fatty acids have been shown to delay the progression of coronary artery plaque and increase the fibrous cap thickness of the plaque.
• What Can You Do?: Consider talking to your doctor about omega-3 fatty acid supplementation, and maintaining a healthy lifestyle, including a balanced diet and regular exercise.