Numerous studies have demonstrated that if the LDL cholesterol is substantially brought down, reversal of coronary artery disease will likely occur. Some high LDL subjects with coronary heart disease were treated by lowering their LDL, and others with conventional heart disease therapy. The results are compared in Figure 13: Reducing LDL Reverses Heart Disease.25
About one in five patients that has a heart attack has a total cholesterol below 200. Although these patients will likely have other risk factors such as smoking or a low HDL, physicians have conventionally not paid attention to their total or LDL cholesterol. However, a recent study has shown that heart attack patients that already have "desirable" cholesterol levels will gain further benefit from a program that brings their cholesterol down even further.26
Vegetarian Diet Reduces Cardiac Occurrences
Further support for the diet with reduced cholesterol and total lifestyle approach is provided by the St. Thomas' Atherosclerosis Regression Study (STARS).27 This British study moved closer to the diet program that Ornish used and, as expected, produced results that were between those achieved on the NCEP diet and those on the Lifestyle Heart Trial regimen. The STARS researchers went beyond the NCEP Step II diet in a number of ways. They: (1) added a significant amount of plant fiber to the diet (up to 6 grams per 1000 calories); (2) further decreased cholesterol intake, amounting to only 100 to 120 mg per day for many of the participants; and (3) increased polyunsaturated fat in the diet. All of these changes made the diet closer to a vegetarian diet than the NCEP diet.
They also counseled patients against smoking and "advised a suitable level of daily exercise." However, the description of these components in their report suggests that relatively little attention was given to these areas compared to Ornish's structured focus on exercise. When angiograms done at the beginning of the STARS were compared with those done an average of about 3 years later, the results were as expected. That is, the results were between those achieved by Ornish and those seen with the NCEP diet. Specifically, regression occurred in 38 percent, while 15 percent progressed; about half did not show any significant change.
However, this dietary approach decreased the number of cardiac events. When they looked at the total of all the strokes, heart attacks, deaths, coronary bypass surgeries, and angioplasties, they realized they made a remarkable impact. Whereas ten percent of control patients had one of these events, only three percent of the diet-treated patients had one.
HDL Did Not Rise In the Lifestyle Heart Trial
What about HDL cholesterol? As we saw in the previous chapter, the higher the HDL cholesterol the better as far as heart disease is concerned. The HDL values for the two groups are compared in Figure 14: HDL Cholesterol Changes in the Lifestyle Heart Trial.
Both groups had a slight decrease in HDL, which is so small as to be statistically insignificant. However, the experimental group still experienced reversal of coronary heart disease despite their low HDL. I believe this makes an important statement: if you have coronary artery disease, lowering your LDL is more important than raising your HDL. The control group had a higher HDL, which is considered to be healthy, but their coronary artery disease still got worse, which suggests again that lowering LDL may be more important in regression of atherosclerosis. However, do not think that the role of HDL is of no importance. We will look at HDL concerns more closely later in the chapter.
