Do Statin Drugs Prevent Progression or Reverse Atherosclerotic Plaque?
This question comes up form time to time, and is an important one, since people with heart disease are interested in interventions which can prevent progression or reverse atherosclerotic plaque formation in the coronary arteries.
The coronary calcium score studies (16), Hi-Speed CAT scan coronary angiogram studies, and intravascular ultrasound studies (15) reveal in-vivo imaging of atherosclerotic plaque over time and can provide these answers.
Some of the calcium score studies (such as Budoff's (26)) showed reduced progression or even regression of calcium score, suggesting a reduction in atherosclerotic plaque with statin drug treatment.(15-26)
However, some of the calcium score studies were disappointing, showing no improvement in calcium score with statin treatment. This was thought to be due to reduction in soft plaque with no reduction in the calcific plaque. (15-26)
Can Statin Drugs Reverse Plaque ?
The totality of all the imaging studies provides fairly strong evidence that statin drug treatment is capable of halting progression, or even regression of atherosclerotic plaque in various locations in the arterial tree. However, the problem arises as to what happens to the rest of the patient. For example, the Calcium score study done with the banned statin drug, Baychol, showed striking regression of atherosclerotic plaque. (16) However, the drug was banned after killing fifty people. This brings to mind the old sarcastic medical comment, "The operation was a success but the patient died."
What is the Price ?
So the final answer is that, yes, intervention with statin drugs can halt progression or reverse atherosclerotic plaque. However, the price in adverse effects is great, with non-cardiac mortality offsetting reduction in cardiac mortality, explaining the lack of all-cause mortality benefit in primary prevention studies, and for studies in women, and in studies in the elderly (PROSPER). After all, statin drugs are mitochondrial toxins, and a reduction in serum cholesterol is an unhealthy intervention which causes disruption of normal cell physiology. Low serum cholesterol is associated with increased mortality from NON-cardiac causes. Dr Judith Walsh reviews these problems and concludes that it is time to change direction in health policy. (27)
What are the other interventions to halt progression or reverse heart disease?
This brings us inexorably to the question of what are the alternatives to statin drugs?
There is strong supporting evidence that optimization of hormone levels is a valuable intervention for prevention of heart disease associated with minimal adverse effects. These include thyroid hormone, testosterone, estrogen and vitamin D (which is also a steroidal hormone).
HUNT Study - Thyroid Function and Heart Disease
The Hunt Study is strong evidence optimizing thyroid function to reduce mortality from heart disease. People (Men and Women) in the upper third of thyroid function (lower third of TSH range) had 70% reduction in mortality from heart disease.(28,29) (LINK)