Can Increasing HDL level potentially help reverse plaque buildup?

I recently experienced an MI. Angiogram shows 60-75% blockage in D1.
Original recommendation was not to do stent because they don't hold up well in small arteries. Presently treating with ASA,Plavix,Metoprolol,Crestor and Nitro patch at night. If I  do not like being on medication the stent is an option. Has anyone had positive results with exercise, change in diet and focusing on increasing HDL to control/reduce blockage? Thanks

[erijon]

It has been studied as noted by the excerpt from the NIH below. There has been a small plaque regression with LDL levels below 70, increased HDL, statin therapy and aerobic exercise;

"BACKGROUND: The purpose of this study was to explore the effect of lifestyle modification, mainly daily aerobic exercise, on coronary atherosclerosis in patients with coronary artery disease (CAD).

METHODS AND RESULTS: A 6-month prospective observational study was conducted with 84 CAD patients receiving pravastatin treatment in order to evaluate the relationship between lifestyle modification, in particular aerobic exercise, and plaque volume as assessed by intravascular ultrasound (IVUS). Lifestyle during the study period was assessed by the-lifestyle modification score. A significant decrease in plaque volume by 12.9% was observed after 6 months of pravastatin therapy (P<0.0001 vs baseline). The change in plaque volume correlated with the change in the serum level of high-density lipoprotein cholesterol (HDL-C) (r=-0.549, P<0.0001), non-HDL-C (r=0.248, P=0.03), low-density lipoprotein cholesterol/HDL-C (r=0.505, P<0.0001), apolipoprotein (apo) A-1 (r=-0.335, P=0.007) and apoB/apoA-1 (r=0.335, P=0.007), and lifestyle modification score (r=-0.616, P<0.0001). There was a clear positive correlation between a change in the serum HDL-C level and lifestyle modification score. Multivariate regression analysis revealed that the increase in serum HDL-C level and lifestyle modification score were independent predictors of coronary plaque regression.

CONCLUSIONS: An appropriate combination of statin therapy and lifestyle modification, in particular, physical activity, may result in coronary plaque regression. This combined treatment strategy, inducing an increase of the serum HDL-C, may contribute to coronary plaque regression."

Hope this helps,

Jon

[jrbon]

Don´t be mislead, even if you get the stent, you will need to continue with medication (perhaps you can spare the Nitro patches).

Jesus.

[ed34]

I believe that study was done in Japan last year? The NIH calls is a 'small' regression, but come on, 12.9% in just 6 months is massive. We could, according to that study, remove a quarter of our plaque in just one year. I don't call that small, I could be plaque free in around 4 years.
Again we see no mention of which processes are taking place, the chemical reactions or anything. It simply mentions high HDL being responsible. Perhaps someone can show me where calcium is absorbed by HDL? Calcium is stored in the skeleton, transported as ions or bonded to Serum albumin, not HDL.
All other research I've read simply says such regimes CAN STABILISE plaque, they mention nothing about actual regression. I wonder why so many patients regularly exercising and taking statins are finding that they require more stents.
On a last note, the report states 84 CAD patients were used. It doesn't state how many showed a 12.9% decrease in plaque? was it just one? 10? 60? all 84?

[erijon]

I can PM the link to you if you like. The study details can be pulled up if you wish. I

[kenkeith]

Circ J. 2010;74(5):954-61. Epub 2010 Mar 17.

Coronary plaque regression and lifestyle modification in patients treated with pravastatin. - Assessment mainly by daily aerobic exercise and an increase in the serum level of high-density lipoprotein cholesterol -.
Tani S, Nagao K, Anazawa T, Kawamata H, Furuya S, Takahashi H, Iida K, Matsumoto M, Washio T, Kumabe N, Hirayama A.

Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan. ***@****

Abstract
BACKGROUND: The purpose of this study was to explore the effect of lifestyle modification, mainly daily aerobic exercise, on coronary atherosclerosis in patients with coronary artery disease (CAD).

METHODS AND RESULTS: A 6-month prospective observational study was conducted with 84 CAD patients receiving pravastatin treatment in order to evaluate the relationship between lifestyle modification, in particular aerobic exercise, and plaque volume as assessed by intravascular ultrasound (IVUS). Lifestyle during the study period was assessed by the-lifestyle modification score. A significant decrease in plaque volume by 12.9% was observed after 6 months of pravastatin therapy (P<0.0001 vs baseline). The change in plaque volume correlated with the change in the serum level of high-density lipoprotein cholesterol (HDL-C) (r=-0.549, P<0.0001), non-HDL-C (r=0.248, P=0.03), low-density lipoprotein cholesterol/HDL-C (r=0.505, P<0.0001), apolipoprotein (apo) A-1 (r=-0.335, P=0.007) and apoB/apoA-1 (r=0.335, P=0.007), and lifestyle modification score (r=-0.616, P<0.0001). There was a clear positive correlation between a change in the serum HDL-C level and lifestyle modification score. Multivariate regression analysis revealed that the increase in serum HDL-C level and lifestyle modification score were independent predictors of coronary plaque regression.

CONCLUSIONS: An appropriate combination of statin therapy and lifestyle modification, in particular, physical activity, may result in coronary plaque regression. This combined treatment strategy, inducing an increase of the serum HDL-C, may contribute to coronary plaque regression.

[ed34]

If this was a scientific study, then you must be able to reproduce the results. Who else has run this study and confirmed it?
Another question which comes to mind is the level of the disease those 84 patients had. Let's face it, to choose 84 people and get them doing aerobic exercises must have been very selective. Most CAD sufferers I know couldn't do that, they would end up with heart failure.

[erijon]

You can also Google the "Asteroid Study" which was a predecessor to this study in Japan. The more recent study in Japan backed up Asteroid's findings;

"346 participants completed a two year course of treatment with the cholesterol drug, rosuvastatin (Crestor®), 40 mg (the maximum FDA-approved dose). The volume of coronary plaque was assessed using intracoronary ultrasound (IVUS), both at the start and after the 24-month treatment period. (IVUS is an invasive procedure performed during heart catheterization.)

Dr. Steven Nissen of the Cleveland Clinic, lead investigator of ASTEROID, reported that plaque was reduced by an average of 6.9% in the (10 mm) segments studied in each participant.

To achieve this endpoint, participants started with an average LDL cholesterol 130 mg and HDL of 43 mg. Two years of rosuvastatin yielded LDL cholesterols of 60.8 mg, HDL of 49 mg."



The problem with both of these studies is the control group size and duration. Larger studies are needed to get more significant results.

[westfort]

Thanks for the replies. So far I plan to increase exercise up to 30 min/day. Drink Cranberry juice, eat almonds/walnuts, lose some weight (10 lbs so far), try some fish and
continue with a glass or 2 of Red Wine a few times a week. Increase fruits and vegetables and limit food high in LDL. If any reduction can be achieved it will go along way to maintaining good health.