Blockage Reversal Evidence

Scientific Literature

The controversy surrounding the possibility of reversal of coronary artery disease has been put to rest by multiple well-conducted scientific trials. Let us now discuss some of the best evidence that supports the fact that blockage reversal is possible.

1. Whole Foods plant-based diet for coronary artery disease reversal

In 1995, Caldwell Esselstyn, published the results of a small but well-conducted study to demonstrate the power of the whole foot plant-based diet and reversal of blockages. (1) Significant angiographic reversal in the blockages were seen with diet control alone. The evidence was again replicated in a larger trial of 198 patients in 2014. One criticism of the study was that the strict dietary regimen excluded all dairy, meat, and oils and was therefore impractical. However, the fact remains that the patients recruited in the trial underwent intensive counseling, and a compliance rate of 87% was achieved. 

2. Lifestyle transformation trial for coronary artery disease reversal

Dean Ornish 1998 published his data on intensive lifestyle changes for the reversal of coronary heart disease. This randomized controlled trial included 48 patients. The intervention consisted of intensive lifestyle changes including a vegetarian diet with less than 10% fat, exercise, stress management training, smoking cessation, and group psychosocial support for five years. All patients underwent coronary angiography before and after the trial period. More regression of coronary atherosclerosis occurred in the intervention arm compared to the control arm. The improvement in blockages was more pronounced after five years than after one year. In contrast, in the control group, coronary atherosclerosis progressed and, more events occurred during the follow-up (4)


3. Statin therapy and CAD Reversal

REVERSAL (5) was the first statin trial and demonstrated a halting of the progression of atherosclerosis with high-dose Atorvastatin. The average LDL achieved in the intervention arm was 79. ASTEROID (6), SATURN (7), and PRECISE IVUS (8), were three subsequent trials enrolling over 1500 patients collectively. All three trials demonstrated plaque regression as evaluated by intravascular imaging. The statins used were either Rosuvastatin 40 mg or atorvastatin 80 mg. The LDL levels achieved in the intervention were 63 mg/dl. The plaque regression was evaluated with intravascular ultrasound.

4. PCSK9 Monoclonal antibodies and CAD Reversal



1.Esselstyn CB Jr, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract. 1995 Dec;41(6):560-8. PMID: 7500065.

Esselstyn CB Jr, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract. 1995 Dec;41(6):560-8. PMID: 7500065.

3.Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. doi: 10.1001/jama.280.23.2001. Erratum in: JAMA 1999 Apr 21;281(15):1380. PMID: 9863851.

4. Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, Davignon J, Erbel R, Fruchart JC, Tardif JC, Schoenhagen P, Crowe T, Cain V, Wolski K, Goormastic M, Tuzcu EM; ASTEROID Investigators. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA. 2006 Apr 5;295(13):1556-65. doi: 10.1001/jama.295.13. jpc60002. Epub 2006 Mar 13. PMID: 16533939.

5.Fineschi M, Gaspardone A. Lo studio Saturn [The Saturn study]. G Ital Cardiol (Rome). 2012 Jul-Aug;13(7-8):469-73. Italian. doi: 10.1714/1114.12242. PMID: 22781373.

6.Tsujita K, Sugiyama S, Sumida H, Shimomura H, Yamashita T, Yamanaga K, Komura N, Sakamoto K, Oka H, Nakao K, Nakamura S, Ishihara M, Matsui K, Sakaino N, Nakamura N, Yamamoto N, Koide S, Matsumura T, Fujimoto K, Tsunoda R, Morikami Y, Matsuyama K, Oshima S, Kaikita K, Hokimoto S, Ogawa H; PRECISE–IVUS Investigators. Impact of Dual Lipid-Lowering Strategy with Ezetimibe and Atorvastatin on Coronary Plaque Regression in Patients with Percutaneous Coronary Intervention: The Multicenter Randomized Controlled PRECISE-IVUS Trial. J Am Coll Cardiol. 2015 Aug 4;66(5):495-507. doi: 10.1016/j.jacc.2015.05.065. PMID: 26227186.

7.Puri R, Nissen SE, Somaratne R, Cho L, Kastelein JJ, Ballantyne CM, Koenig W, Anderson TJ, Yang J, Kassahun H, Wasserman SM, Scott R, Borgman M, Nicholls SJ. Impact of PCSK9 inhibition on coronary atheroma progression: Rationale and design of Global Assessment of Plaque Regression with a PCSK9 Antibody as Measured by Intravascular Ultrasound (GLAGOV). Am Heart J. 2016 Jun; 176:83-92. doi: 10.1016/j.ahj.2016.01.019. Epub 2016 Feb 17. PMID: 27264224.

8.Nicholls SJ, Nissen SE, Prati F, Windecker S, Kataoka Y, Puri R, Hucko T, Kassahun H, Liao J, Somaratne R, Butters J, Di Giovanni G, Jones S, Psaltis PJ. Assessing the impact of PCSK9 inhibition on coronary plaque phenotype with optical coherence tomography: rationale and design of the randomized, placebo-controlled HUYGENS study. Cardiovasc Diagn Ther. 2021 Feb;11(1):120-129. doi: 10.21037/cdt-20-684. PMID: 33708484; PMCID: PMC7944215.

9.Räber L, Ueki Y, Otsuka T, Losdat S, Häner JD, Lonborg J, Fahrni G, Iglesias JF, van Geuns RJ, Ondracek AS, Radu Juul Jensen MD, Zanchin C, Stortecky S, Spirk D, Siontis GCM, Saleh L, Matter CM, Daemen J, Mach F, Heg D, Windecker S, Engstrøm T, Lang IM, Koskinas KC; PACMAN-AMI collaborators. Effect of Alirocumab Added to High-Intensity Statin Therapy on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction: The PACMAN-AMI Randomized Clinical Trial. JAMA. 2022 May 10;327(18):1771-1781. doi: 10.1001/jama.2022.5218. PMID: 35368058; PMCID: PMC8978048.