Can You Reverse Plaque Buildup in Your Arteries?

Atherosclerosis refers to hardening of arteries (blood vessels) from the buildup of plaque in the vessel wall. Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death globally.

Understanding Plaque Buildup

Plaque (otherwise known as atheroma) is composed of cholesterol, calcium, and other cellular debris. It sticks to the inner walls of your arteries. Plaque formation begins with certain stimuli activating the inner lining cells and smooth muscle cells in the arterial wall. This happens from sustained exposure to a range of pathogenic factors such as smoking, high blood pressure, diabetes, high cholesterol levels and stress.

This process, if left unchecked, can lead to serious complications like heart attacks, strokes, and peripheral artery disease.

Can You Reverse It? 

To answer this question, it is necessary to understand the definition of plaque regression. Traditionally, plaque regression has been defined as increases in the diameter of the artery measured by coronary angiography.

In the current era of technological advances in imaging modalities, plaque regression may be best defined as changes in the physical structure and appearance of the plaque that reduce risk of cardiovascular trouble. Plaque buildup can change over time, gaining or losing high risk features. 

Good news is that significant improvements through plaque stabilization is possible through lifestyle changes and medical interventions nowadays to prevent further buildup and improve arterial health. Think of it less as "reversing" and more as "stabilizing and reducing" the plaque. The focus shifts from eliminating existing plaque to preventing further buildup and improving arterial function. Therefore, it is important to address changes early in the course of the disease.   

Strategies to Improve Arterial Health

Treatment targeting plaque regression can broadly be divided into two main categories: dietary/lifestyle and  pharmacological. Pharmacologic treatments have had by far the most success. While diet, exercise and smoking are clearly associated with increased risk, the impact on coronary plaque regression is limited.

• Diet:  A heart-healthy diet is paramount.  This means:
  • Reducing saturated and trans fats. Found in red meat, processed foods, and fried foods.
  • Limiting cholesterol intake.  Focus on lean protein sources.
  • Increasing fiber intake.  Fruits, vegetables, and whole grains help lower cholesterol.
  • Boosting omega-3 fatty acids.  Found in fatty fish like salmon and tuna.
  • Controlling sugar intake.  High sugar levels contribute to inflammation and plaque formation.
• Exercise Regularly:  Regular physical activity improves blood flow, lowers blood pressure, and helps your body utilize cholesterol more effectively. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week.
• Manage Your Weight:  Obesity is a significant risk factor for atherosclerosis.  Weight loss, even modest amounts, can significantly improve arterial health.
• Quit Smoking:  Smoking is a major contributor to atherosclerosis.  Quitting is one of the most impactful things you can do for your cardiovascular health.
• Manage Stress:  Chronic stress contributes to inflammation, which plays a role in plaque formation.  Practice stress-reducing techniques like meditation, yoga, or deep breathing exercises.
• Control Blood Pressure and Cholesterol:  Work with your doctor to manage high blood pressure and high cholesterol through medication and lifestyle changes.
• Consider Medications:  Your doctor may prescribe medications like statins to lower cholesterol levels and prevent further plaque buildup. 

Medical Intervention May Be Needed

Other than medications, you might need additional medical interventions to address severe cases:

• Angioplasty and Stenting:  These procedures can open blocked arteries.
• Coronary Artery Bypass Graft (CABG):  This surgery creates new pathways for blood to flow around blocked arteries.

The Bottom Line

Adopting a heart-healthy lifestyle is the most effective way to protect your arteries and reduce your risk of heart disease and stroke.  

People who should get screened for atherosclerosis include those with a family history of early cardiovascular disease, high cholesterol levels, hypertension, diabetes, men over 45 years of age and women over 55 years of age, and anyone with other risk factors like metabolic syndrome or a sedentary lifestyle.

Reach out to your CHI Health Cardiologist to discuss your individual risk factors and create a personalized plan to improve your arterial health.

References:

1. Coronary atherosclerotic plaque regression, review article by Dawson et al, published in the Journal of American College of Cardiology, 2022 Jan,79(1) 66-82
2.  Atherosclerosis: By Jordan Strom and Peter Libby. Pathophysiology of heart disease. Edited by Leonard Lilly, Fifth Edition, pages 113-134
3.  The clinical relevance of the reversal of coronary atherosclerotic plaque: Cesaro et al., European Journal of Internal Medicine, Volume 129, November 2024, pages 16-24