Treating the Cause to

Prevent and Reverse

Heart Disease

Caldwell B. Esselstyn Jr., M.D.

Dr Esselstyn reports no known

financial conflicts.

Is the Therapy of Coronary Artery

Disease the Radical Mastectomy

of the 21st Century?

Amer J Cardiology, Sept 2010

Absence of Coronary Artery

Disease

• Rural China

• Papua Highlanders

• Central Africa

• Tarahumara Indians

• All males 65 years and older, and all

females 70 years and older, who have been exposed to the traditional western diet have cardiovascular disease and should be treated as such.

Lewis Kuller, M.D.

Univ. of Pittsburgh

April 2007

Three Stages in the Movement of Endothelial Progenitor

Cells from Bone Marrow to Vascular Endothelium

HDL

• High HDL efflux protects against

atherosclerosis

• HDL blood levels are not indicative of

HDL’s efflux capacity

• Statins do not increase HDL efflux

capacity

N Engl J Med 2011; 364:127

HDL’s Apolipoprotein A-1 (apo A-1)

• Responsible for reverse cholesterol

transport

• May be damaged by oxidation or

inflammation

• Damaged apo A-1 is proinflammatory

and atherogenic

Nat. Rev. Cardiol.

Adv. Publication Feb 8, 2011

NO Nitric oxide

Nitric oxide synthase

DDAH

Dimethyl arginine

Dlimethyl amino hydrolase

Oxidative Stress

all major risk factors

Treating The Cause

Endothelial Cell

Endothelial Progenitor Cell

HDL Cholesterol

Dimethyl Arginine Dimethylamino

Hydrolase

Statins and Primary Prevention

The benefit, if any, is very small

Arch Intern Med

2010 June 28

Intervention and Cardiac Drug

Downside

• Mortality

• Morbidity

• Expense

• Increasing failure rate with

time

Unmet Potential for

Cardiovasular Disease

Prevention in the United States

The current path leads to increasing

adiposity, diabetes mellitus,

cardiovascular disease, and disability

and unfit, socially isolated population

stuffed with pills and subjected to

frequent palliative procedures.

Circulation 2009;120:1171-1173

Participants 1985 - 1988

23 men, 1 woman with severe triple vessel coronary artery disease – age range 44 - 68

Method

• Oil

• Fish

• Fowl

• Meat

• Dairy

• Caffeinated

Coffee

Avoid

Lecithin and Carnitine

Eggs Poultry

Milk Pork

Cream Duck

Dairy Lamb

Liver Venison

Red Meat Shell Fish

Fish

Lecithin Gut

Carnitine Bacteria TMAO Vascular Disease

Foods to be Included

• Whole Grains

• Legumes, lentils

• Vegetables

• Fruit

Baseline Mean Cholesterol

• 237 mg/dl

Lipids

5 years 12 years

Total cholesterol 137 mg/dl 145 mg/dl

HDL 37 mg/dl 38 mg/dl

LDL 76 mg/dl 82 mg/dl

Triglycerides 143 mg/dl 143 mg/dl

12 – Year Analysis of Dropouts

6 Patients – 13 New Cardiac Events

Increased angina 4

Ventricular tachycardia 2

Bypass surgery 4

Angioplasty 1

Congestive heart failure 1

Death from arrhythmia 1

8 Years Prior to Study

49 Coronary Events in 18 Patients

Increased angina 18

Angiographic disease progression 13

Bypass surgery 7

Infarctions 4

Strokes 3

Angioplasty 2

Worsening stress test 2

18 Patients Followed 12 Years

• 49 coronary events during 8 years

prior to study

• None in 17 compliant patients

during 12 years

Treating the Cause

3.75 Years Follow-Up

Lost to Follow Up 2

Adherent (89%) 177

Non-Adherent 21

TOTAL 200

‘SEVERITY INDEX’

Patients With Intervention (119)

Patients Avoiding Intervention (27)

Severity Index 146/177 = 82%

Recurrent Events(%)

Adherent 0.6

Non-Adherent 62

Benefits For Adherent Participants

Disease Reversal 22%

Angina (Improved or Resolved) 93%

Mean Weight Loss 8.5 kg

Recurrent Cardiac Events 0.6%

Treating The Cause

Arrest and Reversal Outcomes

• No mortality from the diet

• No morbidity from the diet

• Benefits improve with time

Quality of Life Issues

Patients are empowered by the

knowledge that they are in control of

the disease that was destroying their

lives

Baseline Cholesterol 261 mg/dl

10-14 days 126 mg/dl

Left Right

Before Rx After Rx

Esselstyn 2007

Baseline Cholesterol 248 mg/dl

10-14 days 137 mg/dl

Left Right

Before Rx After Rx

Esselstyn 2007

8 Measures of Cardiovascular Disease Reversal

Isn’t Chronic Illness

One Disease?

Epidemiology of Third World &

Developing Countries examples

Diabetes

Sugars

Days

Glu

co

se

50

100

150

200

250

300

0 2 4 6 8 10 12 14 16 18 20

Diet

Visit

David Schewmon

Osteoporosis

Usual Diet Usual Diet Plant Protein

x 1 wk

Uri

ne C

alc

ium

(m

g/d

l)

0

100

200

300

400

500

David

Schewmon