World Heart Day 2023: Is it possible to reverse cholesterol clogging in arteries or atherosclerosis?

Cholesterol plaque in arteries can block blood flow to the heart or brain, causing heart attacks and strokes. (Photo by Alexandru Acea via Unsplash)

More than half a billion people around the world are affected by cardiovascular diseases (CVD). Atherosclerosis, or build-up of cholesterol plaque on the walls of the arteries, is the primary cause of heart attacks and strokes and accounts for close to one-third of all deaths globally (World Heart Foundation’s World Heart Report 2023 – Confronting the World’s Number One Killer). If you've heard of someone getting an angiography or angioplasty done lately, these are the procedures used to check for and address cholesterol-linked blockages in blood vessels.

Understanding the role of cholesterol in the pathogenesis of atherosclerosis is considered to be among the greatest discoveries of the 20th century, according to a 2006 article in The Texas Heart Institute Journal. In 1904, German pathologist Felix Marchand (1846-1928) apparently first introduced the term ‘atherosclerosis’ and suggested that atherosclerosis was responsible for almost all obstructive processes in the arteries. Then, in 1913, Russian pathologist Nikolai N. Anichkov (1885-1964) showed that cholesterol alone caused the atheromatous changes in the vascular (blood vessel) wall. His classic experiments in 1913 paved the way to our current understanding of the role of cholesterol in cardiovascular disease.

Worldwide, in younger patients the risk of atherosclerosis is more in males than females but with age this advantage of women diminishes markedly. Heart attacks are three-fold more common and five times more fatal in men than women. The reason is favourable lipid profile in females possibly because of various protective hormones. In addition, fewer women smoke compared with men, which is an important risk factor.

World Heart Day (September 29) is a reminder to everyone around the world to take care of their heart. The good news is atherosclerosis can be managed with lifestyle changes and medication, and may be even reversed in some patients. Extreme diets can reverse it, says Dr Kashif Sayed, M.D. DNB (Medicine), DNB (Cardiology); Consultant- Interventional Cardiology, Crescent Hospital & Heart Centre, Nagpur (Maharashtra). He cites the example of how in autopsies, coronary arteries of people during World War II showed no or very little atherosclerosis because of starvation but as the conditions improved and lifestyle changed, arteries again started to show signs of atherosclerosis.

Statins

A class of drugs called statins has been shown to reverse atherosclerosis in various clinical trials. When started early, this drug has been shown to reverse soft plaques (plaques which have high fluid fat) and stabilize them, preventing their rupture.

Lifestyle modifications and statins can reverse atherosclerosis in some patients, Dr Sayed adds.

Risk factors

Statins are good heart companions but is bad lifestyle the main villain here? Dr Abraham Paul, MD, DM, Intervention cardiologist, Apollo Adlux Hospital, Kerala, says that lifestyle plays a major role but dissuades anyone from calling lifestyle the sole villain. “There are other factors like genetics, age, and sometimes just plain bad luck that can also mess with your ticker. That said, making positive changes (to lifestyle) can actually turn things around. We're talking about eating better, moving more, and cutting out smoking and excessive drinking,” Dr Paul added.

So, while lifestyle might be a key character in the heart health drama, it’s also the part of the story where you have the most control. Think of it less as a villain and more as an opportunity to be the hero to your own heart.

Must-dos for good heart health

Dr Abraham Paul’s must-dos to reverse or stop the progression of atherosclerosis include:

Eat Heart-smart: You don’t need to follow a fad diet, just stick to the basics. Go for fruits, veggies, lean meats, and whole grains. The Mediterranean or DASH diets are great starting points.

Get Moving: Aim for at least 150 minutes of moderate exercise a week. You can even break it up—take a brisk walk during lunch, cycle in the evening, or get those steps in while shopping. Don't forget to toss in some weight training a couple of days a week.

Quit Smoking: If you're still smoking, quitting is non-negotiable—it’s one of the most significant risk factors for heart disease.

No Alcohol: No amount of alcohol is safe. Abstain from alcohol and your heart will thank you.

Chill, Don’t Stress: Stress can directly cause heart diseases. Try stress-busting techniques like meditation or deep-breathing exercises.

Regular Check-ups: Routine screenings aren’t just for peace of mind; they catch potential problems like high cholesterol or high blood pressure early on. Make sure to get those numbers checked regularly.

Consultations: Regular visits to your healthcare provider can help tailor your heart-care plan.

Get Your Shots: Surprisingly, some vaccines, like the flu shot, can give your heart an extra layer of protection by preventing respiratory infections that make heart problems worse.

What are the most technologically advanced medical intervention in atherosclerosis?

There are many treatment options available for coronary artery atherosclerosis, like angioplasty in which a catheter is inserted through the wrist or leg to open up the blocked artery - sometimes doctors do a balloon angioplasty to push the cholesterol plaque back and open up the artery.

Various new technologies to diagnose atherosclerosis, like IVUS (intravascular ultrasound), OCT (optical coherence tomography), are now available. Difficult blocks can now be opened by modalities like Rotablation, orbital atherectomy, LASER.

Similarly, bypass operations can now be performed on beating heart and through a small incision (MIS), Dr Sayed explains.

CVD insurance claims in India

According to Niva Bupa Health Insurance Company, in India, on an average 13 percent of all claim amounts paid by Niva Bupa have been for cardiovascular diseases. About 3 percent of all claims received for people in the age group up to 45, 19 percent of all claims paid in the age group of 40-60 and 22 percent for 60+ age were paid for cardiovascular diseases. CVD claim by gender was female: 4 percent, male: 9 percent.

The top 5 heart conditions for which Niva Bupa has paid claims include: Angina Pectoris (chest pain), Myocardial Infarction (heart attack), Hypertension (high blood pressure), Valvular Disease, and Cardiac Arrest.

Market Size

According to Data Bridge Market Research, the market for atherosclerosis treatment was valued at US$ 2.55 billion in 2021 and is expected to reach US$4.11 billion by 2029, registering a CAGR of 6.16 percent during the forecast period of 2022-29.