From the Guidelines
Adopting a plant-based diet rich in fruits, vegetables, whole grains, legumes, nuts, and seeds, such as the Mediterranean diet, is the most effective dietary approach to reverse atherosclerosis, as supported by the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline 1. This should be combined with limiting or eliminating animal products, especially red meat and full-fat dairy, while avoiding trans fats, refined carbohydrates, and processed foods. The Mediterranean and DASH diets have shown particular promise, with a recent study highlighting a 30% reduction of total CVD among individuals randomized to a Mediterranean diet plus extra-virgin olive oil or mixed nuts 1. Key components of these diets include:
- High intake of monounsaturated fats, polyunsaturated fats, and complex carbohydrates
- Higher dietary fiber intake, associated with improvement in CVD risk factors, including lower BP, improved insulin sensitivity, and support of weight loss goals 1
- Reduction in saturated fatty acids, with healthier fat and carbohydrate intake, lowering LDL-C, which is associated with lower CVD morbidity and mortality rates 1 Beyond diet, regular aerobic exercise (at least 150 minutes weekly), stress management techniques, quality sleep (7-9 hours nightly), and avoiding tobacco are crucial lifestyle components. Weight management is important, as excess weight contributes to atherosclerosis progression. These approaches work by reducing LDL cholesterol, increasing HDL cholesterol, lowering blood pressure, decreasing inflammation, improving endothelial function, and enhancing overall cardiovascular health. For those with established disease, these lifestyle changes should complement medical therapy, not replace it, and should be implemented under healthcare supervision for optimal results, as recommended by the 2022 standards of medical care in diabetes 1.
From the Research
Diets to Reverse Atherosclerosis
- The Mediterranean diet has been shown to decrease atherosclerosis progression in coronary heart disease patients, as demonstrated by reduced intima-media thickness of both common carotid arteries (IMT-CC) and carotid plaque height 2.
- A diet rich in extra virgin olive oil, such as the Mediterranean diet, can decrease LDL atherogenicity in high cardiovascular risk individuals by increasing LDL resistance against oxidation, reducing LDL oxidative modifications, and increasing estimated LDL particle size 3.
- Evidence-based heart-healthy eating patterns, such as those recommended by the American Heart Association (AHA), American College of Cardiology (ACC), and the National Lipid Association (NLA), can improve cardiometabolic risk factors, dyslipidemia, and ASCVD risk 4.
Lifestyle Changes to Reverse Atherosclerosis
- Lifestyle interventions, including diet and physical activity, remain the mainstay of non-interventional treatment of coronary atherosclerosis, with reversal seen in many studies 5.
- Control of modifiable risk factors, such as obesity, smoking, diabetes mellitus, and hypertension, can be beneficial in reversing atherosclerosis 5, 6.
- Physical activity recommendations from the AHA, ACC, and NLA can optimize lipids and prevent ASCVD 4.
Additional Considerations
- Limiting excessive intake of dietary cholesterol, saturated fats, and trans fats, and incorporating dietary adjuncts such as viscous fiber, plant sterols/stanols, and probiotics, may also be beneficial in reducing ASCVD risk 4.
- Pharmacotherapy, including statins, fibrates, ezetimibe, and PCSK9 monoclonal antibodies, can also play a role in reducing atherosclerosis progression and ASCVD risk 6.