Treating the Cause to
Prevent and Reverse
Heart Disease
Louisville September 2013

Caldwell B. Esselstyn Jr., M.D.
Absence of Coronary Artery
Disease
•
•
•
•

Rural China
Papua Highlanders
Central Africa
Tarahumara Indians
Treating The Cause

Endothelial Cell
Endothelial Progenitor Cell
HDL Cholesterol
Dimethyl Arginine Dimethylamino
Hydrolase
Moderation Kills
• Most lipid lowering studies show a
slower progression of coronary
artery disease
• 30% fewer new heart ...
Intervention and Cardiac Drug
Downside
•
•
•
•

Mortality
Morbidity
Expense
Increasing failure rate with
time
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
Caffeinated
Coffee
Lecithin and Carnitine
Eggs
Milk
Cream
Dairy
Liver
Red Meat

Poultry
Pork
Duck
Lamb
Venison
Shell Fish
Fish
Lecithin
Carnitine

Gut
Bacteria TMAO

Vascular Disease
Foods to be Included
•
•
•
•

Whole Grains
Legumes, lentils
Vegetables
Fruit
Baseline Mean Cholesterol

• 237 mg/dl
Lipids
Total cholesterol
HDL
LDL
Triglycerides

5 years
12 years
137 mg/dl 145 mg/dl
37 mg/dl 38 mg/dl
76 mg/dl 82 mg/dl
1...
8 Years Prior to Study
49 Coronary Events in 18 Patients
Increased angina
Angiographic disease progression
Bypass surgery
...
18 Patients Followed 12 Years
• 49 coronary events during 8 years
prior to study
• None in 17 compliant patients
during 12...
Treating the Cause
3.75 Years
Lost to Follow Up
Adherent
(89%)
Non-Adherent
Total

2
177
21
200
Diagnosis of
Coronary Artery Disease
Angiography/CT Angiography
180
Stress Tests
74
Myocardial Infarction
44
Comorbidities
Hyperlipidemia

161

Hypertension

60

Diabetes

23

Prior Myocardial Infarct

44
Outcomes for 177 CAD Adherent
Participants
Improved
Reversal
Stable

144
39
15
Outcomes for 177 CAD Adherent
Participants
Worse
Unrelated to Nutrition
1PCP stopped clopidegrel resulting in stent closur...
Outcomes for 177 CAD Adherent
Participants
Disease Progression
1 Stroke
2 CABG
1 Restenting
Death
5 Non Cardiac
0 Cardiac
Outcomes for 21 CAD NonAdherent Participants
Improved
Stable
Worse
Disease Progression
2 Stroke
4 PCI with stent
3 CABG
1 ...
Recurrent Events
Adherent
Non-Adherent

0.6%
62%
27 Avoided Previously Recommended
Interventions
119 Had Intervention Prior to Counseling
146 = 82% Severity Index
177
Outcomes of 177 Adherent CAD
Participants
Reported angina at Baseline
112
Reported angina improvementor resolution
104 (93...
Treating the Cause Benefit Summary
of
Adherent Participants
Disease Reversal
22%
Angina Improved or Resolved
93%
Mean Weig...
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 destroyin...
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

50

Visit
0

2

4

6

8

10

Days

12

14

16

18

20

David Schew...
Osteoporosis

Urine Calcium (mg/dl)

500

400

300

200

100

0

Usual Diet

Usual Diet

Plant Protein
x 1 wk

David Schew...
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
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Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease

  1. 1. Treating the Cause to Prevent and Reverse Heart Disease Louisville September 2013 Caldwell B. Esselstyn Jr., M.D.
  2. 2. Absence of Coronary Artery Disease • • • • Rural China Papua Highlanders Central Africa Tarahumara Indians
  3. 3. Treating The Cause Endothelial Cell Endothelial Progenitor Cell HDL Cholesterol Dimethyl Arginine Dimethylamino Hydrolase
  4. 4. 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% ?
  5. 5. Intervention and Cardiac Drug Downside • • • • Mortality Morbidity Expense Increasing failure rate with time
  6. 6. Participants 1985 - 1988 23 men, 1 woman with severe triple vessel coronary artery disease – age range 44 - 68
  7. 7. Method Avoid • • • • • • • Oil Fish Fowl Meat Dairy Caffeinated Coffee
  8. 8. Lecithin and Carnitine Eggs Milk Cream Dairy Liver Red Meat Poultry Pork Duck Lamb Venison Shell Fish Fish
  9. 9. Lecithin Carnitine Gut Bacteria TMAO Vascular Disease
  10. 10. Foods to be Included • • • • Whole Grains Legumes, lentils Vegetables Fruit
  11. 11. Baseline Mean Cholesterol • 237 mg/dl
  12. 12. Lipids Total cholesterol HDL LDL Triglycerides 5 years 12 years 137 mg/dl 145 mg/dl 37 mg/dl 38 mg/dl 76 mg/dl 82 mg/dl 143 mg/dl 143 mg/dl
  13. 13. 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
  14. 14. 18 Patients Followed 12 Years • 49 coronary events during 8 years prior to study • None in 17 compliant patients during 12 years
  15. 15. Treating the Cause 3.75 Years Lost to Follow Up Adherent (89%) Non-Adherent Total 2 177 21 200
  16. 16. Diagnosis of Coronary Artery Disease Angiography/CT Angiography 180 Stress Tests 74 Myocardial Infarction 44
  17. 17. Comorbidities Hyperlipidemia 161 Hypertension 60 Diabetes 23 Prior Myocardial Infarct 44
  18. 18. Outcomes for 177 CAD Adherent Participants Improved Reversal Stable 144 39 15
  19. 19. Outcomes for 177 CAD Adherent Participants Worse Unrelated to Nutrition 1PCP stopped clopidegrel resulting in stent closure and MI 1 Patient with atrial fibrillation refused Warfarin and suffered a non-fatal stroke 2CABG in asymptomatic patients with stable CAD who were persuaded by PCP 2 CABG to be eligible for valvular repair surgery 1 PCI with stenting to be eligible for valve surgery 2 PCI with stenting for occluded grafted LIMA
  20. 20. Outcomes for 177 CAD Adherent Participants Disease Progression 1 Stroke 2 CABG 1 Restenting Death 5 Non Cardiac 0 Cardiac
  21. 21. Outcomes for 21 CAD NonAdherent Participants Improved Stable Worse Disease Progression 2 Stroke 4 PCI with stent 3 CABG 1 Endarterectomy for PAD 1 Heart Transplant Death Non-Cardiac Cardiac 0 8 13 11 2 0 2
  22. 22. Recurrent Events Adherent Non-Adherent 0.6% 62%
  23. 23. 27 Avoided Previously Recommended Interventions 119 Had Intervention Prior to Counseling 146 = 82% Severity Index 177
  24. 24. Outcomes of 177 Adherent CAD Participants Reported angina at Baseline 112 Reported angina improvementor resolution 104 (93%)
  25. 25. Treating the Cause Benefit Summary of Adherent Participants Disease Reversal 22% Angina Improved or Resolved 93% Mean Weight Loss kg. 8.5
  26. 26. Treating The Cause
  27. 27. Arrest and Reversal Outcomes • No mortality from the diet • No morbidity from the diet • Benefits improve with time
  28. 28. Quality of Life Issues Patients are empowered by the knowledge that they are in control of the disease that was destroying their lives
  29. 29. Baseline Cholesterol 10-14 days Left 248 mg/dl 137 mg/dl Right Before Rx After Rx Esselstyn 2007
  30. 30. Isn’t Chronic Illness One Disease? Epidemiology of Third World & Developing Countries examples
  31. 31. Diabetes 300 Diet Sugars Glucose 250 200 150 100 50 Visit 0 2 4 6 8 10 Days 12 14 16 18 20 David Schewmon
  32. 32. Osteoporosis Urine Calcium (mg/dl) 500 400 300 200 100 0 Usual Diet Usual Diet Plant Protein x 1 wk David Schewmon

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