From the Guidelines
Both statins and lifestyle changes can partially reverse atherosclerotic plaque buildup in coronary and cerebral blood vessels, with high-intensity statin therapy and comprehensive lifestyle modifications being the most effective approach. The evidence from the 2019 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline 1 supports the use of maximally tolerated doses of statins in secondary prevention of ASCVD, which can reduce LDL-C levels by an average of at least 50%. This reduction in LDL-C levels can lead to a decrease in plaque volume, as shown in studies that have demonstrated a 1-2% per year reduction in plaque volume with consistent high-intensity statin therapy 1.
The most effective approach to reversing atherosclerotic plaque buildup is a combination of statins and comprehensive lifestyle modifications, including:
- A Mediterranean or plant-based diet low in saturated fats
- Regular aerobic exercise (150+ minutes weekly)
- Smoking cessation
- Stress management
- Maintaining healthy blood pressure and blood glucose levels
This combination therapy works by:
- Lowering LDL cholesterol
- Reducing inflammation
- Improving endothelial function
- Promoting plaque stabilization
The reversal process is gradual, typically requiring at least 1-2 years of consistent therapy to see measurable regression. While complete plaque elimination is unlikely, significant regression can occur, particularly in earlier-stage disease. The degree of reversal varies between individuals and depends on factors like plaque composition, disease duration, and adherence to treatment. Regular monitoring through imaging studies can help track progress and adjust treatment as needed 1.
From the Research
Reversal of Atherosclerotic Plaque Build-up
- There is evidence to suggest that statins can reverse atherosclerotic plaque build-up in coronary or cerebral blood vessels 2, 3, 4, 5.
- Studies have shown that high-dose atorvastatin can halt and, in some cases, reverse atherosclerotic progression 3.
- Rosuvastatin has been found to be more effective than atorvastatin in reducing the total atheroma volume and percent atheroma volume, and improving the lumen volume 4.
- A study comparing rosuvastatin and atorvastatin found that rosuvastatin showed more rapid and robust plaque stabilization, and regression of plaque volume compared to atorvastatin 5.
Lifestyle Changes
- There is no direct evidence provided in the studies to suggest that lifestyle changes can reverse atherosclerotic plaque build-up in coronary or cerebral blood vessels.
- However, it is well-established that lifestyle changes such as a healthy diet, regular exercise, and not smoking can help to reduce the risk of cardiovascular disease and slow the progression of atherosclerosis.
Statin Therapy
- Statin therapy has been shown to be effective in reducing major cardiovascular events in both secondary and primary prevention of coronary heart disease 3.
- The use of potent statins at very low doses may overcome patient statin reluctance and provide a cost-effective approach to cardiovascular disease prevention 6.
- The choice of statin and dose may depend on the individual patient's risk factors and response to treatment 6.