How Not to Age — Presentation

[Virilius]

I’m not surprised that a plant-based diet low in (saturated) fat and high in fiber alongside exercise helps with various conditions.

[AnUser]

That’s the minimum found in the literature which they used to try and prove statins could clinically significantly regress plaque, basically they had an incentive to find the lowest requirement. Other definitions require more. Since statins doesn’t clinically significantly regress plaque, it cannot nor has not been advertised as such.

The regression in the Ornish study in percent diameter stenosis was 1.75% at the 1 year mark and 3.07% at the five year mark.

The definition of clinical significant regression includes a 0.2 mm or greater increase in minimum diameter as well.

It was 0.01 at the 1 year mark, so it would require a 20 x increase, and at the 5 year mark 0.001, a 200 x increase would be required to meet the criteria.

[mondagai]

The best bit was when he shit all over resveratrol

[AnUser]

@Neo

@AnUser snd @Virilius what are your thoughts on this short thread

Oldest/most papers on heart disease where actual reversal of plaque/stenosis demonstrated

No as there was no reversal of plaque demonstrated, a mere decrease in percent diameter stenosis does not mean so. There needs to be an increase in minimum diameter as well.

[Neo]

Do you think this is meaningful or meaningless? Or do you think the results are not real?

[AnUser]

The result in the graph is meaningless without minimum diameter as I said. If you increase the reference diameter without changing the minimum diameter then the percent stenosis decreases without any regression in plaque. That’s why you need both and it needed to be 200 times larger than it was, and with 7% more reduction in diameter stenosis.

[Neo]

Interesting (extra char)

[AnUser]

The point is that the Ornish study or any other study for any other therapy has not shown any regression or reversal of plaque to a clinically relevant degree, and the Ornish study didn’t even show any regression.

The two important points is that the protocol reduced events and plaque didn’t progress.

[Davin8r]

@AnUser

The point is that the Ornish study or any other study for any other therapy has not shown any regression or reversal of plaque to a clinically relevant degree

Ok, I thought you were trying to say that the Ornish study showed no regression but that statin and other drug studies have. Clearly multiple different therapies have shown evidence of “regression”, but the term “clinically significant” is a key differentiator and obviously the thing we actually care about.

One assumption, which may or may not be true, is that regression over time for any treatment is linear, when in fact it could accelerate in a non-linear fashion if continued for longer. In which case plain old “regression” in a short period of time could actually be “clinically significant” if extended long enough.

If we looked at (for instance) a high saturated fat diet for a year and saw plaque progression, should it be dismissed as “clinically insignificant” if it didn’t show enough progression in that limited period of time?

[AnUser]

No, but it wasn’t clinically significant either way.
That statin study did show regression in plaque since minimum lumen diameter improved while percent diameter stenosis decreased unlike the Ornish trial, but it was not clinically significant.

@Davin8r

One assumption, which may or may not be true, is that regression over time for any treatment is linear, when in fact it could accelerate in a non-linear fashion if continued for longer. In which case plain old “regression” in a short period of time could actually be “clinically significant” if extended long enough.

If we looked at (for instance) a high saturated fat diet for a year and saw plaque progression, should it be dismissed as “clinically insignificant” if it didn’t show enough progression in that limited period of time?

The Ornish trial had a 200x requirement for increase in minimum lumen diameter at 5 year mark, while 20x at 1 year I don’t think there is any evidence it is non-linear.

Plaque progression is a different thing.

[Davin8r]

I should know better than to open my mouth when I’m away on vacation and can’t really dig into this topic of plaque regression. I hope someone is checking Anuser’s work because I don’t have time to!

[AnUser]

@Bicep

I think if I’m pretty good for a few more years my CAC will be lower and possibly zero.

If you really want to measure this you should probably do a CT angiogram, to see soft plaque as well, if you’re serious about risk and not just playing around.

• This gives a better sense of the luminal narrowing and the presence of soft plaque

Heart Disease: Labs & Diagnostic Tests - Peter Attia

CT Angiogram, A New Way to Detect Plaque

Your CAC has also increased over time…

[AnUser]

50% of fatal MI’s occur in non-calcified areas of coronary arteries.

Coronary calcium score: what it means and how to interpret your results (AMA #5)

[Davin8r]

@AnUser

The regression in the Ornish study in percent diameter stenosis was 1.75% at the 1 year mark and 3.07% at the five year mark.

The definition of clinical significant regression includes a 0.2 mm or greater increase in minimum diameter as well.

Where are you getting this “minimum diameter” criterion from? Is it from CCTA, which wasn’t available at the time of the Ornish study?

@AnUser

It was 0.01 at the 1 year mark, so it would require a 20 x increase, and at the 5 year mark 0.001, a 200 x increase would be required to meet the criteria.

From where are you getting these numbers?

[AnUser]

@Davin8r

Is it from CCTA, which wasn’t available at the time of the Ornish study?

How Not to Age — Presentation

The definition of reversal or regression of plaque is defined as following in the literature: Clinically relevant regression or progression was defined as a nominal change (from baseline to 2 years) of ≥10% for percent diameter stenosis11 and ≥0.2 mm (prespecified) for MLD. https://www.ahajournals.org/doi/10.1161/circulationaha.108.773747 The Ornish study does not meet that criteria, therefore it is not regression or reversal of plaque (both can be said, but it is most commonly referred to as regression, and as I showed earlier Greger uses it as cure). From Ornish study: Average percent diameter stenosis regressed from 40.0% at baseline to 37.8% 1 year later, a change that was correlated with the degree of lifestyle change. Even that 3% reduction is questionable.

@Davin8r

From where are you getting these numbers?

It’s in the Ornish study.

[Davin8r]

Ok, so just to be clear when you say the 0.2mm/10% criteria for “clinically relevant regression in the literature”, you are referring to a single paper when you say “in the literature”, not some firmly-established generally agreed-upon criteria established in cardiology.

Because one could argue that a smaller degree of regression IS clinically significant, based on the positive clinical outcomes in the experimental group of the Ornish study.

[Davin8r]

BTW, great review paper from 2022 on coronary artery atherosclerosis regression, one of the only ones I could find, published in JACC:

https://www.jacc.org/doi/10.1016/j.jacc.2021.10.035

They use the term “regression” freely for quite a few statin drug studies and note that it isn’t yet known what exactly is “clinically significant”. In fact, “regression” can mean change in plaque quality (from unstable to more stable) without a decrease in plaque volume.

[AnUser]

@Davin8r

Ok, so just to be clear when you say the 0.2mm/10% criteria for “clinically relevant regression in the literature”, you are referring to a single paper when you say “in the literature”, not some firmly-established generally agreed-upon criteria established in cardiology.

It’s not one paper and I think that’s how it works.

@Davin8r

Because one could argue that a smaller degree of regression IS clinically significant, based on the positive clinical outcomes in the experimental group of the Ornish study.

No, since you are not using what is considered clinically significant reduction in the literature. Either way, in that case you would have to accept that a progression of disease is clinically significant reversal of ASCAD because it also can coincide with a reduction of outcomes. It makes no sense. It is not reversal of plaque and thus atherosclerotic coronary artery disease (ASCAD).

If you see my responses to @Neo you will see why you need an increase in minimum diameter as well and why it is included in the definition.

How Not to Age — Presentation

Oldest/most papers on heart disease where actual reversal of plaque/stenosis demonstrated No as there was no reversal of plaque demonstrated, a mere decrease in percent diameter stenosis does not mean so. There needs to be an increase in minimum diameter as well. [image]

How Not to Age — Presentation

The result in the graph is meaningless without minimum diameter as I said. If you increase the reference diameter without changing the minimum diameter then the percent stenosis decreases without any regression in plaque. That’s why you need both and it needed to be 200 times larger than it was, and with 7% more reduction in diameter stenosis.

[Davin8r]

@AnUser

It’s not one paper and I think that’s how it works

I’d recommend reading the review paper I posted. The cut-off point for “clinically significant” is subjective/unknown when applied to diameter stenosis and MLD based on the current state of the literature. Smaller changes can be clinically (i.e. real-world) significant, as suggested by outcomes in the Ornish study.

[AnUser]

@Davin8r

The cut-off point for “clinically significant” is subjective/unknown when applied to diameter stenosis and MLD based on the current state of the literature.

It’s not unknown and all definitions are subjective, unless you want me to argue for definitions being objective, and the Ornish study used Quantitative Coronary Angiography, so you need a definition for clinically relevant regression (or regression at all) pertaining to that.

@Davin8r

Smaller changes can be clinically (i.e. real-world) significant, as suggested by outcomes in the Ornish study.

Or rather an intervention can improve outcomes without regression of plaque, clinically relevant or not… There was no regression as a result of the intervention.

Read again why minimum lumen diameter has to increase.

If you accept that reversal is a decrease in percent stenosis without an increase in MLD (which can happen because the reference diameter increases, like vasodilation), then you’d have to accept that pomegranate juice reverses disease, which Ornish has studied, or nitrates, and a bunch of other interventions with similar results.