Analyses & Studies
Focus Healthcare: Non-Surgical Treatment to Reverse Blocked Coronary Arteries
Hard truths about heart disease
Coronary heart disease is one of the top killers in Singapore accounting for 1 in 5 deaths in 2023. On average, 34 heart attacks occur every single day, and even more disturbing is that more of these heart attacks are occurring in younger people aged 45 year or less. Heart disease is a silent killer, often the heart arteries supplying blood to the heart block up quietly and slowly. Many sufferers don’t experience any significant symptoms until it has become severe or after they have had a heart attack.
Early detection and risk stratification for prevention
Exactly because of this insidious nature; early detection and identification of high-risk individuals are key strategies in its prevention and treatment. Non-invasive imaging techniques with Computed Tomographic (CT) scans allow accurate assessment of the health of the coronary arteries and detect blockages in the blood vessels even before there are symptoms. Identification of risk factors forms the other cornerstone of heart disease management. Risk factors include hypertension, diabetes, high cholesterol, smoking, lack of exercise, obesity, poor sleep, stress, air pollution, excess alcohol, chronic inflammation and genetic predisposition.
What should I do next if I have blocked arteries?
Early detection and quantifying an individual’s cardiovascular risk is just the beginning. What should we do once blockages are found? A common misconception is that blockages must have surgery or stents to treat, but this can’t be further from the truth. Some cases of severe blockages may indeed benefit from ballooning and stents inserted into the arteries to dilate the blood vessels (a procedure known as percutaneous coronary angioplasty, Fig. 1), other more severe or extensive disease may need coronary artery bypass grafting surgery. However, thankfully many blockages do not, and this applies even to seemingly tight blockages causing more than 70% narrowing, these can still be safely and effectively treated with a combination of therapeutic lifestyle interventions and medications. Heart blockages that are asymptomatic and/or have undergone special evaluations known as functional tests and passed, may be treated safely with a combination of medication and aggressive risk factor modification through lifestyle interventions. These key therapies reduce inflammation, decrease the likelihood of blood clots and improve vascular health and function. This strategy has been shown to stabilize blockages and even shrink them over time, thereby reducing the risk of developing heart attack and its complications in the future. This process of shrinking the cholesterol deposits (called atherosclerotic plaques) in the blood vessels that cause blockages is called “plaque regression” or “medical angioplasty” as opposed to the surgical methods mentioned above (Fig. 2).
Non-surgical treatment and lifestyle medicine to reverse coronary heart disease
Studies have shown that nine reversible risk factors contribute significantly to the development and progression of heart blockages. These are 1) High cholesterol 2) Hypertension 3) Diabetes 4) Smoking 5) Obesity 6) Poor diets, especially ones lacking fruits and vegetables 7) Lack of exercise 8) Excessive alcohol 9) Psychosocial stress, and poor or inadequate sleep.
Once it is determined that invasive treatment is not required, a detailed assessment of the individual’s nine reversible risk factors and heart attack risk estimate is made in order to prescribe a personalized treatment plan combining holistic lifestyle optimization and medication. Using lifestyle interventions to improve the above lifestyle risk factors is known as lifestyle medicine. The American College of Lifestyle Medicine defines it as the use of evidence-based lifestyle therapeutic intervention—including a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection—as a primary modality, delivered by clinicians trained and certified in this specialty, to prevent, treat, and often reverse chronic disease. Targeting these 6 pillars, the doctor is in better position to educate, activate, and initiate a lifestyle-first approach with patients at risk for or with established heart disease. Studies have shown better stabilization and even reversal of blockages by those following an Ornish or Esselstyne diets. Cardiac rehabilitation programs consisting of guided exercise and aggressive risk factor modifications have also shown similar positive effects on blockages. Intensive cholesterol lowering through a combination of dietary adjustments and lipid lowering medications is another key driver of plaque regression.
Conclusion
Despite advances in detection and treatment, coronary heart disease remains a major cause of death and disability in Singapore and the world. Fortunately, most coronary artery blockages can be effectively prevented, stabilized or even reversed with non-surgical methods consisting of appropriate use of plaque modifying medication, and optimization of one’s lifestyle habits performed adequately in a measurable and consistent manner.
By Dr Peter Ting, Senior Consultant Cardiologist, Harley Street Heart & Vascular Centre
