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Caldwell Esselstyn, MD - Treating the Cause to Prevent and Reverse Heart Disease
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  • 1. Treating the Cause to Prevent and Reverse Heart Disease Louisville September 2013 Caldwell B. Esselstyn Jr., M.D.
  • 2. Absence of Coronary Artery Disease • • • • Rural China Papua Highlanders Central Africa Tarahumara Indians
  • 3. Treating The Cause Endothelial Cell Endothelial Progenitor Cell HDL Cholesterol Dimethyl Arginine Dimethylamino Hydrolase
  • 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. Intervention and Cardiac Drug Downside • • • • Mortality Morbidity Expense Increasing failure rate with time
  • 6. Participants 1985 - 1988 23 men, 1 woman with severe triple vessel coronary artery disease – age range 44 - 68
  • 7. Method Avoid • • • • • • • Oil Fish Fowl Meat Dairy Caffeinated Coffee
  • 8. Lecithin and Carnitine Eggs Milk Cream Dairy Liver Red Meat Poultry Pork Duck Lamb Venison Shell Fish Fish
  • 9. Lecithin Carnitine Gut Bacteria TMAO Vascular Disease
  • 10. Foods to be Included • • • • Whole Grains Legumes, lentils Vegetables Fruit
  • 11. Baseline Mean Cholesterol • 237 mg/dl
  • 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. 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. 18 Patients Followed 12 Years • 49 coronary events during 8 years prior to study • None in 17 compliant patients during 12 years
  • 15. Treating the Cause 3.75 Years Lost to Follow Up Adherent (89%) Non-Adherent Total 2 177 21 200
  • 16. Diagnosis of Coronary Artery Disease Angiography/CT Angiography 180 Stress Tests 74 Myocardial Infarction 44
  • 17. Comorbidities Hyperlipidemia 161 Hypertension 60 Diabetes 23 Prior Myocardial Infarct 44
  • 18. Outcomes for 177 CAD Adherent Participants Improved Reversal Stable 144 39 15
  • 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. Outcomes for 177 CAD Adherent Participants Disease Progression 1 Stroke 2 CABG 1 Restenting Death 5 Non Cardiac 0 Cardiac
  • 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. Recurrent Events Adherent Non-Adherent 0.6% 62%
  • 23. 27 Avoided Previously Recommended Interventions 119 Had Intervention Prior to Counseling 146 = 82% Severity Index 177
  • 24. Outcomes of 177 Adherent CAD Participants Reported angina at Baseline 112 Reported angina improvementor resolution 104 (93%)
  • 25. Treating the Cause Benefit Summary of Adherent Participants Disease Reversal 22% Angina Improved or Resolved 93% Mean Weight Loss kg. 8.5
  • 26. Treating The Cause
  • 27. Arrest and Reversal Outcomes • No mortality from the diet • No morbidity from the diet • Benefits improve with time
  • 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. Baseline Cholesterol 10-14 days Left 248 mg/dl 137 mg/dl Right Before Rx After Rx Esselstyn 2007
  • 30. Isn’t Chronic Illness One Disease? Epidemiology of Third World & Developing Countries examples
  • 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. Osteoporosis Urine Calcium (mg/dl) 500 400 300 200 100 0 Usual Diet Usual Diet Plant Protein x 1 wk David Schewmon