What Causes Soft Plaque in Arteries and How To Reverse It

Robert Todd Hurst (0:03)

Can you really reverse heart artery disease? Well, that's the exact question that this patient asked me a little bit over a year ago. So to set this stage, this gentleman was a bit frustrated because he had been doing everything he can to stop artery disease. He had a family history, so he's paying attention. He's been taking a statin for a very long time, but he had also been paying attention to his health. His cholesterol numbers are good, his blood pressure is good, his blood sugar insulin levels are good, he's active, he feels well. But we had gotten a CT angiogram with plaque composition analysis that he found discouraging. So CT angiogram is an X-ray of the heart arteries. It tells us mostly about blockages. The newer technology, and one he'd never had before, was the plaque composition analysis. So this is software that analyzes the walls of the heart artery, measures how much plaque is there, and then tells us how much of that is calcified and how much of that is soft. And you can see his results here. So it's measured in volume. You can see his calcified plaque volume is 117 cubic milliliters. The non-calcified plaque volume, 320 cubic milliliters. That's suggested that he's still been making plaque.

And even maybe more importantly, this low attenuation plaque was 25 cubic milliliters. So the low attenuation plaque is the stuff that's thought to be concerning. You can see that the radiologist called the total plaque volume, 437, considered severely 67th percentile. So at the time we had met, he really felt like there wasn't much else that he could do. But I saw it a different way. I knew that he didn't have actually optimal cholesterol numbers. And so rather than shooting for an LDL less than 70, which was the guideline recommendations there, I shared with him data that showed that an APO-B or LDL level less than 35 may be the level that we want to get people to that have the highest risk for artery disease. There's evidence that it lowers the risk of the things we really care about, like heart attacks and strokes and stents. But it also is the level that gets us the best potential results in reversing soft plaque. So we did the CT angiogram, we went on aggressive therapy to lower his LDL APO-B even further. Generally his numbers over the year when we checked it were in the 20s. And we repeated his CT angiogram a year later. And here's the results. You can see that his total or his soft plaque volume went from 320 to 157 cubic milliliters. So less than half of the soft plaque volume. Low attenuation plaque went to zero, and his percentile went from 67th to 37th percentile.

If that doesn't show you that we can reverse artery disease, I don't know what else will.

The whole CT angiograms, doing those serially is something a little bit newer to our world.

I really started doing the CT angiograms, the plaque composition analysis, in most of my patients about a year and a half ago, and so I have now about 20 people that have had repeat CT angiograms. What I'll tell you is that the thing that's been most striking to me is that the people that are being treated to guideline goals of LDL cholesterol, meaning less than 70 or maybe less than 55, those people are either staying stable or they're actually progressing their soft plaque. The ones that are getting those exceptional LDL ApoB levels, those are the people that I am seeing regression in. So I don't want to say that it's all about cholesterol because it's not. You know, coronary artery disease, artery disease, there's at least seven different root causes for this. There's none that you need to ignore or you can ignore. You have to pay attention to all of those. But my point on this is that if you are, then you're going to get exceptional results.

Most importantly, lowering the risk of heart attacks, of strokes, of dementia, but also getting the lowest or the best opportunity to reverse that soft plaque. We'll see what happens over time. This gentleman, very excited about his results, of course, but he also said, okay, well, what's next?

If we do this again in a year or five years, am I going to have no soft plaque left? I don't know yet. This technology is relatively new, but that's my goal. That's my hope. So I think we can all agree that traditional healthcare is failing people, being reactive, one-size-fits-all, disease-focused. At HealthspanMD, we believe that exceptional healthcare needs to be proactive, looking for opportunities to optimize health. It needs to be personalized. Just like with this gentleman, although he met all the guidelines, we weren't getting the results we needed. We needed to personalize his approach for him. And then lastly, focusing on Healthspan. How do we add those healthy, vibrant years? That's our mission to transform health care from treating disease to adding healthy, vibrant, strong, mentally sharp years to life. If that's a mission that resonates with you, I invite you to go to our website, healthspanmd.com and learn more about how we are working to transform health care.