Without a doubt, the words of Ben Franklin ring true, “an ounce of prevention is worth a pound of cure”. Unfortunately, the current medical model does not recognize the early detection of atherosclerosis using coronary calcium CT imaging or carotid intimal medial thickness (CIMT) measurements as routine and most patients are identified at advanced stages of disease. The most commonly selected conventional therapies, such as stent placement and bypass surgery, do nothing to alter the pathophysiology of atherosclerosis. The future of medicine must shift to prevention and reversal of atherosclerosis at earlier stages of pathology. However, there are already methods using evidence-based medicine to reverse atherosclerosis. The foundation of this is nutritional as has been previously reviewed (1). Are there other approaches?

Over 60 years ago the idea that atherosclerosis could be reversed using chelation therapy with disodium ethylene diamine tetraacetic acid or EDTA began to be used for the treatment of atherosclerosis despite definitive scientific evidence for its efficacy and safety. The Trial to Assess Chelation Therapy (TACT) was developed and received funding from the National Institutes of Health (NIH) to ascertain the safety and efficacy of intravenous (IV) chelation therapy in patients with CVD. This pivotal trial was published in 2013 and demonstrated an improvement in outcomes in post-myocardial infarction (MI) patients. The TACT showed a particularly large reduction in CVD events and all-cause mortality in the subgroup of patients with diabetes. The results support the concept of metal chelation to reduce metal-catalyzed oxidation reactions that promote the formation of advanced glycation end products, a precursor of diabetic atherosclerosis. The ongoing TACT2, limited to patients with prior MI and diabetic mellitus type 2, is further examining this unique therapy in the hope that it may enter the armamentarium to reduce the atherosclerotic risk of their diabetic patients (3). A clinical trial of a proprietary agent that included EDTA is available orally and also demonstrated reversal of atherosclerosis without the challenges of recurrent IV infusions (4). 

Beyond chelation, other promising therapies for the reversal of atherosclerosis using nutraceutical therapies have appeared. In a recently published randomized study from China, 76 patients with carotid atherosclerosis were treated with either nattokinase(NK) 6,000 FU or simvastatin 20 mg (5). In both groups cholesterol fell, and in the NK group HDL rose, but reversal of atherosclerosis over 26 weeks was profound with NK and plaque volume fell by 37%. Another agent, bergamot, was studied in patients with atherosclerosis over 6 months without randomization (6). Lipid fractions improved as anticipated during therapy with bergamot and there was a stunning decrease in the CIMT from 1.2 cm to 0.9 cm. A final promising combination therapy has been reported to promote the reversal of carotid atherosclerosis (7). The study combined pycnogenol with centella asiatica and followed 391 patients with ultrasound measurements of plaque for over 4 years in a randomized trial. The progression of plaque over time was least in the patients treated with the combination nutraceutical and there was reduction in the number of angina episodes and myocardial infarctions in the treated cohort.

Advances in the detection, prevention and reversal of atherosclerosis are sorely needed. These studies give hope that even for patients with advanced disease, nutritional and nutraceutical therapies can improve their quality and quantity of life.