Treating the Cause to Prevent and Reverse Heart Disease. Caldwell B. Esselstyn Jr., M.D.

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1 Treating the Cause to Prevent and Reverse Heart Disease Caldwell B. Esselstyn Jr., M.D.

2 Dr Esselstyn reports no known financial conflicts.

3 Is the Therapy of Coronary Artery Disease the Radical Mastectomy of the 21 st Century? Amer J Cardiology, Sept 2010

4 Absence of Coronary Artery Disease Rural China Papua Highlanders Central Africa Tarahumara Indians

7 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

16 Three Stages in the Movement of Endothelial Progenitor Cells from Bone Marrow to Vascular Endothelium

18 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

19 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

20 NO Nitric oxide Nitric oxide synthase DDAH Dimethyl arginine Dlimethyl amino hydrolase Oxidative Stress all major risk factors

21 Treating The Cause Endothelial Cell Endothelial Progenitor Cell HDL Cholesterol Dimethyl Arginine Dimethylamino Hydrolase

22 Statins and Primary Prevention The benefit, if any, is very small Arch Intern Med 2010 June 28

23 Intervention and Cardiac Drug Downside Mortality Morbidity Expense Increasing failure rate with time

24 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:

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

26 Method Avoid Oil Fish Fowl Meat Dairy Caffeinated Coffee

28 Lecithin and Carnitine Eggs Milk Cream Dairy Liver Red Meat Poultry Pork Duck Lamb Venison Shell Fish Fish

29 Lecithin Gut Carnitine Bacteria TMAO Vascular Disease

30 Foods to be Included Whole Grains Legumes, lentils Vegetables Fruit

32 Baseline Mean Cholesterol 237 mg/dl

33 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

40 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

41 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

42 18 Patients Followed 12 Years 49 coronary events during 8 years prior to study None in 17 compliant patients during 12 years

44 Treating the Cause 3.75 Years Follow-Up Lost to Follow Up 2 Adherent (89%) 177 Non-Adherent 21 TOTAL 200

45 SEVERITY INDEX Patients With Intervention (119) Patients Avoiding Intervention (27) Severity Index 146/177 = 82%

46 Recurrent Events(%) Adherent 0.6 Non-Adherent 62

47 Benefits For Adherent Participants Disease Reversal 22% Angina (Improved or Resolved) 93% Mean Weight Loss 8.5 kg Recurrent Cardiac Events 0.6%

48 Treating The Cause

53 Arrest and Reversal Outcomes No mortality from the diet No morbidity from the diet Benefits improve with time

54 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

63 Baseline Cholesterol 261 mg/dl days 126 mg/dl Left Right Before Rx After Rx Esselstyn 2007

64 Baseline Cholesterol 248 mg/dl days 137 mg/dl Left Right Before Rx After Rx Esselstyn 2007

67 8 Measures of Cardiovascular Disease Reversal

68 Isn t Chronic Illness One Disease? Epidemiology of Third World & Developing Countries examples

71 Glucose Diabetes Diet Sugars Days Visit David Schewmon

72 Urine Calcium (mg/dl) Osteoporosis Usual Diet Usual Diet Plant Protein x 1 wk David

Cardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century November 2, 2016

Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century November 2, 2016 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process