How to reverse atherosclerotic (hardening of the arteries) arterial stenosis (narrowing of the arteries)?

From the Guidelines

To reverse atherosclerotic arterial stenosis, a comprehensive approach including dietary changes, regular exercise, medication, and lifestyle modifications is recommended, with a focus on reducing LDL cholesterol and inflammation, as supported by the most recent guidelines from the American Heart Association and American College of Cardiology Foundation 1. The key components of this approach include:

• Dietary changes: Focus on a Mediterranean or plant-based diet rich in fruits, vegetables, whole grains, nuts, and olive oil, while limiting saturated fats, trans fats, and processed foods.
• Regular exercise: Aim for at least 150 minutes of moderate-intensity exercise weekly, as recommended by the American Heart Association 1.
• Medications: Statins, such as atorvastatin 10-80mg daily or rosuvastatin 5-40mg daily, can significantly reduce LDL cholesterol and slow or reverse plaque buildup, as shown in studies such as the PROVE-IT TIMI 22 study 1.
• Lifestyle modifications: Stop smoking completely, manage stress through techniques like meditation or yoga, and maintain healthy blood pressure and blood sugar levels. These approaches work by reducing inflammation, improving endothelial function, decreasing LDL cholesterol oxidation, and enhancing HDL cholesterol's ability to remove fats from arterial walls. Regular medical check-ups are essential to monitor progress and adjust treatment as needed. The process of plaque regression takes time, so consistency with these interventions is crucial for long-term arterial health. Some key points to consider:
• The use of antiplatelet therapy, such as aspirin or clopidogrel, may be recommended for patients with symptomatic atherosclerotic peripheral artery disease of the lower extremity, as supported by guidelines from the American Heart Association and American College of Cardiology Foundation 1.
• The combination of high-dose statin plus fibrate can increase the risk for severe myopathy, and statin doses should be kept relatively low with this combination, as noted in the ACCF/AHA guidelines 1.
• Patients with very high triglycerides should not consume alcohol, and the use of bile acid sequestrants is relatively contraindicated when triglycerides are greater than 200 mg per dL, as recommended by the ACCF/AHA guidelines 1.

From the Research

Reversing Atherosclerotic Arterial Stenosis

To reverse atherosclerotic arterial stenosis, several lifestyle interventions and therapeutic modifications can be considered. The following points highlight some of the key strategies:

• Lifestyle Interventions: Regular physical exercise, body weight management, and healthy dietary patterns have been shown to have preventive and antihypertensive effects 2. Additionally, stress management and promotion of adequate sleep patterns coupled with circadian entrainment may also be beneficial 2.
• Dietary Modifications: The Dietary Approaches to Stop Hypertension (DASH) diet, which is characterized by low sodium and alcohol restriction, may be considered the most effective treatment for reducing blood pressure 3. The Mediterranean diet, which is rich in fruit, vegetables, whole grains, and unsaturated fatty acids, has also been associated with lower risk of sudden cardiac death in postmenopausal women 4.
• Therapeutic Modifications: Targeting multiple modifiable risk factors, such as hypertension, smoking, and dyslipidemia, has become the main therapeutic strategy to improve arterial stiffness in patients at high cardiovascular risk 5. Long-term ω-3 fatty acids (fish oil) supplementation in diet may also improve arterial stiffness in the population with hypertension or metabolic syndrome 5.
• Pharmacological Treatment: Renin-angiotensin-aldosterone system antagonists, metformin, and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors may be useful in individuals with hypertension and diabetes 5. Statin therapy, in combination with adherence to a Mediterranean diet, may offer an additive protection against cardiovascular disease risk 6.
• Other Interventions: Weight reduction, aerobic exercise, and continuous positive airway pressure treatment may improve arterial stiffness in obese populations with obstructive sleep apnea 5. Antibodies against tumor necrosis factor-alpha may be effective in populations with chronic inflammatory disease such as rheumatoid arthritis 5.