Prevent and Reverse
Heart Disease
Caldwell B. Esselstyn Jr., M.D.
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
NEJM. December 3, 2009.
Moderation Kills
• Most lipid lowering studies show a
slower progression of coronary artery
disease
• 30% fewer new heart attacks
• 30% fewer heart attack deaths
• 30% fewer interventions needed
• What about the remaining 70% ?
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
Bypass Surgery
Vein Graft Failure at 12-18
Months in 4,290 Grafts
Endoscopic Harvesting
46.7%
Open Harvesting
38.0%
New Eng J Med 2009;361:235-44
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
Clinton’s Heart Disease
“This is not a result of his lifestyle or diet.
This is a chronic condition. We don’t have
a cure for this condition.”
Allan Schwartz MD
“This kind of disease is progressive.
There aren’t any cures.”
Clyde Yancy MD
A Strategy to Arrest and
Reverse Coronary Artery
Disease: A 12-Year
Longitudinal Study of a
Single Physician’s Practice
Caldwell B. Esselstyn, Jr., MD
Participants 1985 - 1988
23 men, 1 woman with severe triple
vessel coronary artery disease – age
range 44 - 68
Method
Avoid
•
•
•
•
•
Oil
Fish
Fowl
Meat
Dairy
Foods to be Included
•
•
•
•
Grains
Legumes, lentils
Vegetables
Fruit
Baseline Mean Cholesterol
• 237 mg/dl
Lipids
Total cholesterol
HDL
LDL
Triglycerides
5 years
137 mg/dl
37 mg/dl
76 mg/dl
143 mg/dl
12 years
145 mg/dl
38 mg/dl
82 mg/dl
143 mg/dl
12 – Year Analysis of Dropouts
6 Patients – 13 New Cardiac Events
Increased angina
Ventricular tachycardia
Bypass surgery
Angioplasty
Congestive heart failure
Death from arrhythmia
4
2
4
1
1
1
8 Years Prior to Study
49 Coronary Events in 18 Patients
Increased angina
Angiographic disease progression
Bypass surgery
Infarctions
Strokes
Angioplasty
Worsening stress test
18
13
7
4
3
2
2
18 Patients Followed 12 Years
• 49 coronary events during 8 years
prior to study
• None in 17 compliant patients during
12 years
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
CAD Prevention and
Reversal Part II
CAD Prevention and Reversal
Part II
Consecutive Patients
2002-2010
Compliant
Non-Compliant
TOTAL
119 (88%)
14 (12%)
133
CAD Prevention and Reversal
Part II
Average Length Follow Up
40 Months
CAD Prevention and
Reversal Part II
Average Weight Loss Per Patient
25 Pounds
CAD Prevention and
Reversal Part II
Pre-Counseling Interventions Declined
by Patient
Stents 5
CABG 10
TOTAL 15
CAD Prevention and Reversal
Part II
Disease Reversal
Stress Test
Angiogram
Carotid Doppler
CIMT
TOTAL
9
8
1
1
19
CAD Prevention and Reversal
Part II
Disease Progression in
Compliant Patients
Progression
No Progression
TOTAL
1
118
119
Baseline Cholesterol
10-14 days
Left
261 mg/dl
126 mg/dl
Right
Before Rx
After Rx
Esselstyn 2007
Baseline Cholesterol
10-14 days
Left
248 mg/dl
137 mg/dl
Right
Before Rx
After Rx
Esselstyn 2007
Isn’t Chronic Illness
One Disease?
Epidemiology of Third World &
Developing Countries examples
Diabetes
300
Diet
Sugars
Glucose
250
200
150
100
Visit
50
0
2
4
6
8
10
Days
12
14
16
18
20
David Schewmon
Osteoporosis
Urine Calcium (mg/dl)
500
400
300
200
100
0
Usual Diet
Usual Diet
Plant Protein
x 1 wk
David
S h