Prevent and Reverse Heart Disease

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Prevent and ReverseHeart Disease

• Caldwell B. Esselstyn Jr., M.D.

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Absence of Coronary Artery Disease

• Rural China
• Papua Highlanders
• Central Africa
• Tarahumara Indians

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• 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

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Endothelial cell
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• NO

Nitric oxide
Nitric oxide synthase
arginine
ADMA asymetric dimethyl arginine
DDAH Dimethyl arginine Dlimethyl amino
hydrolase Oxidative Stress all major risk
factors
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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 ?

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Intervention and Cardiac Drug Downside

• Mortality
• Morbidity
• Expense
• Increasing failure rate with time

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• Multiple studies show if you have one ruptured
  plaque you have many.

Steve Nissen Cleveland Clinic
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• There is much more liberal use of angioplasty
  and stenting than there needs to be.

Eric Topol, M.D.
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A Strategy to Arrest and Reverse Coronary Artery
Disease A 12-Year Longitudinal Study of a Single
Physicians Practice
Caldwell B. Esselstyn, Jr., MD
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Participants 1985 - 1988

• 23 men, 1 woman with severe triple vessel
  coronary artery disease age range 44 - 68

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Goal

• Maintain total serum cholesterol lt 150 mg/dl
• Maintain LDL serum cholesterol lt 80 mg/dl

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Method
Avoid

• Oil
• Fish
• Fowl
• Meat
• Dairy

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Foods to be Included

• Grains
• Legumes, lentils
• Vegetables
• Fruit

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Baseline Mean Cholesterol

• 237 mg/dl

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Lipids

• 5 years 12 years
• Total cholesterol 137 mg/dl 145 mg/dl
• HDL 37 mg/dl 38 mg/dl
• LDL 76 mg/dl 82 mg/dl
• Triglycerides 143 mg/dl 143 mg/dl

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12 Year Analysis of Dropouts

• 6 Patients 13 New Cardiac Events
• Increased angina 4
• Ventricular tachycardia 2
• Bypass surgery 4
• Angioplasty 1
• Congestive heart failure 1
• Death from arrhythmia 1

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8 Years Prior to Study
49 Coronary Events in 18 Patients Increased
angina 18 Angiographic disease
progression 13 Bypass surgery 7 Infarctions
4 Strokes 3 Angioplasty 2 Worsening stress
test 2
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18 Patients Followed 12 Years

• 49 coronary events during 8 years prior to study
• None in 17 compliant patients during 12 years

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Arrest and Reversal Outcomes

• No mortality from the diet
• No morbidity from the diet
• Benefits improve with time

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Quality of Life Issues

• Patients are empowered by the knowledge that they
  are in control of the disease that was destroying
  their lives

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Most Heart Attacks Caused by Unhealthy Lifestyles

• Studies Blow Away Myth of Bad Genes

We cant cure this disease until we address the
fundamentals of lifestyle.
Eric Topol M.D. Cleveland Plain Dealer, August
20,2003
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Baseline Cholesterol 261 mg/dl 10-14 days 126
mg/dl
Left Right
Before Rx
After Rx
Esselstyn 2007
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Baseline Cholesterol 248 mg/dl 10-14 days 137
mg/dl
Left Right
Before Rx
After Rx
Esselstyn 2007
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v
Cleveland Clinic Heart Center
Best in the Nation 12 Years in a Row
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Isnt Chronic Illness One Disease?
Epidemiology of Third World Developing
Countries examples
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Diabetes
300
Diet
Sugars
250
200
Glucose
150
100
Visit
50
0
2
4
6
8
10
12
14
16
18
20
Days
David Schewmon
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Osteoporosis
500
400
300
Urine Calcium (mg/dl)
200
100
0
Usual Diet
Usual Diet
Plant Protein x 1 wk
David Schewmon
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