Overview

Coronary Heart Disease (CHD) is one of the most common cardiac diseases found worldwide. Globally, around 250 million people live with CHD, with more than 9 million people losing their lives annually due to the disease. Its significance in public health forces researchers and clinicians to consistently improve treatment approaches towards CHD. Although preventing the disease from worsening through surgical interventions has been widely considered achievable, its reversibility has recently gained research focus. Studies over the past decade or so have revealed the importance of long-term, intense lifestyle modification and usage of lipid-lowering drugs in reversing vessel blockage caused by plaque formation. Reaching a definitive answer regarding the reversibility of CHD would add a new dimension to the current approaches to CHD treatment,  one that is more accessible and risk-free.

Understanding coronary heart disease

What is coronary heart disease?

Plaque of unhealthy cholesterol and fats accumulates around the vessel walls of the coronary artery (a condition known as atherosclerosis) causing CHD. This results in reduced blood supply to the heart, leading to symptoms such as fatigue, chest pain, and heart failure in the worst case. CHD is a long-term disease and takes many years to develop. 

Risk factors of coronary heart disease

Lifestyle

Smoking, lack of exercise, and high-fat diet are all risk factors for CHD.

• Smoking – chemicals in cigarettes accelerate atherosclerosis by making the vessel walls stickier, thus increasing the likelihood of clotting 
• Lack of exercise – studies reveal that physical exercises lower the rate of cardiovascular diseases while reducing sedentary activity, positively affecting cardiac health¹
• A high-fat diet with high saturated fatty acids (SFA) increase blood concentration of low-density lipoprotein (LDL), or “bad” cholesterol, which is a key contributor to CHD²

Diseases

A range of health conditions are known to increase the risk of CHD. It includes: 

• Obesity – excess fat deposits in the heart create a pro-inflammatory state, which predisposes to a range of cardiac diseases like CHD³ 
• Chronic kidney disease – the progression of CHD is associated with poor glomeruli (network of blood vessels in the kidney) filtering, which is a key symptom of chronic kidney diseases⁴
• Diabetes – hypertension (high blood pressure) is associated with diabetes, especially type 2 diabetes. It can increase the risk of heart attacks caused by CHD⁵

Genetic risks

CHD is more likely to occur in people with a family history of CHD. When the family member develops CHD at a relatively younger age (before 55 years old). A specific gene at chromosome 9 (9p21 locus) is a carrier of CHD, with an increased risk of 15% to 35%.⁶

Concept of reversing coronary heart disease

Definition of reversal

Reversal is not limited to relieving symptoms or stopping disease progression. It involves undoing damage caused by the disease. In the context of CHD, it refers to the removal/reduction of plaque and curing of vessel lesions caused by atherosclerosis. It is strictly different from risk management or surgical interventions.

Evidence for and against

There are many conflicting arguments regarding the reversibility of CHD. Although several healthcare websites state that CHD is not reversible, when looking into scientific papers, multiple studies have suggested otherwise. 

For example, clinical trials have revealed that intensive lipid-lowering therapies can reverse atherosclerosis.⁷ Additionally, the introduction of a very low-fat diet to people with CHD not only stopped disease development but also reversed vessel damage, especially when combined with lipid-lowering drugs.⁸ In particular, frequent exercises, plant-based diets, and medications including statins and PCSK9 inhibitors are the major contributors to the regression of CHD.⁹ 

Studying small sample sizes does not ensure similar results will be yielded from a much larger population.¹⁰ Such approaches may lack consistency among various ethnic or age groups. Therefore, further study is required to claim that CHD is reversible at a practical level.

How long does the reversal of CHD take?

Moderate regression of CHD was recorded after five years of intensive lifestyle changes, suggesting that its complete reversal would take multiple years, possibly even decades.¹¹ Meanwhile, high-intensity statin therapy recorded significant regression of atherosclerosis after two years.¹² This suggests that medical treatment is more effective compared with lifestyle changes, although combining the two is likely to have the best results. 

Why is it important to know CHD is reversible?

Traditionally, to treat CHD, people undergo heart procedures to achieve normal blood flow to the heart. A primary example is coronary artery bypass graft (CABG), which involves a healthy blood vessel from another part of the body transplanted into the heart.  Avoiding blood circulation to the narrowed segment of the coronary artery. 

Since it is an invasive surgical procedure, several risks are associated with CABG, including stroke, wound infection, renal failure, graft failure, and possibly death.¹³ For such reasons, patients may refuse to undergo CABG and prefer to find solutions that are considered less invasive, such as reversal of CHD through lifestyle modifications. CABG is not possible due to coronary arteries incompatible with grafting. ¹³ Therefore, reversal of CHD would drastically alter the standardised treatment approaches by reducing its risks and increasing accessibility.

How can coronary heart disease be prevented?

CHD can be prevented by following the previously mentioned lifestyles  

• Low intake of high-fat food
• Regular exercise
• Quitting smoking
• Controlling alcohol consumption. 

Stress is also known to increase the risk of CHD. Offloading and managing stress is a key factor in maintaining good cardiac health. 

Having a healthy sleep cycle, as insufficient sleep can elevate the risk of CHD, together with other diseases like obesity, hypertension, and diabetes. 

People undergoing regular screening tests ( cholesterol levels and blood pressure) also detect possible signs of CHD early, improving the likelihood of reversibility and successful treatment.

Frequently asked questions

Which age group and gender is more likely to be affected by coronary heart disease?

In both people assigned male at birth and people assigned female at birth, the risk of CHD increases after 35 years old.¹⁴ As for gender differences, people assigned male at birth are at a higher risk of developing CHD.

What drinks open up arteries?

Studies suggest that chemicals in green tea called Epigallocatechin-3-Gallate (EGCG) can break down proteins and cause vessel blockage. Beetroot juice is also known to improve vessel health by improving blood pressure, endothelium function, and age-related dysfunctions.^{15, 16}

What is the life expectancy for someone with coronary heart disease?

Studies show that CHD is associated with a shorter life expectancy. An average 50-year-old person assigned female at birth can expect to live up to 7.9 years with a CHD, while for a person assigned male at birth is, 6.7 years.¹⁷ Its mortality and dangers are typically misunderstood amongst younger populations, with many expecting to live as long as a healthy individual.¹⁸ It is necessary young people understand the implications of CHD-related risks and focus on a healthy lifestyle to reduce the incidence of CHD.

Summary

To answer the question, it is highly likely that CHD can be reversed, albeit only with long-term intensive lifestyle modifications and medical intervention. It involves the usage of lipid-lowering drugs such as statins, abandoning alcohol/tobacco usage, and increasing daily exercise. Due to the small sample size targeted for this research, some may question the lack of evidence to exclude the diverse groups affected by the disease. Nonetheless, it is still a possible method when treating CHD. The lifestyle changes involved are similar to those that can prevent CHD. Therefore, it is advisable to follow life habits to prevent the onset of CHD in the first place if possible. It is because, despite its possible reversibility, CHD is nonetheless a harmful, life-threatening, and common disease that can affect anyone.