Circulatory problems and heart disease: an interview with Caldwell B. Esselstyn, Jr., M.D

Nutrition Health Review, Spring, 2006

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We have since learned that only about 10 percent of heart attacks occur in the manner I just described. About 88 to 90 percent of heart attacks occur from one of these small, young unstable plaques, which is on the side of the wall of the artery. Under the influence of the traditional Western diet, one of these small plaques eventually ruptures. As long as that artery is not blocked more than 70 percent, the person is unlikely to have any symptoms. However, there is a cascade of events that is tragic and serious.

The contents of this ruptured plaque now begin to ooze out into the circulating walls of the vessel. It activates the platelets, the clotting factors of the blood. Suddenly we now have a thrombosis that reaches all the way across the vessel. Now the vessel is completely closed. This explains the common scenario that people refer to about someone they know who had a heart attack but showed no symptoms and did not appear to be a high-risk candidate for this disease.

Q: Can a vegetarian diet prevent coronary heart disease?

A: The amazing thing is that a heart attack seems to be tragic, but it also is exciting, because within three of four weeks, patients can heal those plaques so they cannot rupture. If patients become totally compliant with plant-based nutrition, the metabolism and the biochemical profile are completely changed. Within weeks, patients can make themselves heart attack--proof. There can be significant lessening of the amount of angina (chest pain). The heart pain may completely disappear. This turnaround is very powerful for these patients to suddenly realize that,

It is interesting to see how patients, especially those who had bypass surgery, a stent, or a recurrence of angina, can be empowered when they see that by making profound changes in their nutrition, they can do within weeks what surgery and stents had failed to do over the long run. They now know that they themselves are the locus of control for this disease. It is reassuring for them and their loved ones to think that they do not have to wait for the other shoe to fall.

Q: Is diet more essential than exercise, stress management, and carefully monitored medications?

A: We know that the patients are achieving this goal when their low-density lipoprotein-cholesterol (LDL-C)--the "bad" cholesterol--goes under 80 mg./dL. (milligrams per deciliter). We try to keep the total cholesterol under 150 mg./dL. I do not mean to reach under 80 mg./dL, by taking a large dose of a statin drug (which lowers cholesterol). Statins can achieve the same result, but they do not efficiently treat the disease.

Q: Do you feel that the widespread use of statin drugs has reduced the incidence of heart attacks?

A: Some studies show that patients who are driving their cholesterol to very low levels by taking statins are not achieving the benefits of stopping the disease. Statins lower the cholesterol number, but the disease continues to progress.

Q: Are coronary bypasses and angioplasty effective? Have these interventions actually extended lives?