No, that’s how those particular authors define the term “clinically significant regression”. Look at the data tables. Only a small percent achieved this. The majority still achieved “regression”. Smaller degrees of regression add up over time as the plaque “reverses”, just as the plaques build up slowly over time.
Per the rosuvastatin paper you cited, only 7% of subjects achieved the authors’ definition of “clinically significant regression”. Also,
“Mean±SD percent diameter stenosis decreased from 37.3±8.4% (median, 35.7%; range, 26% to 73%) to 36.0±10.1% (median, 34.5%; range, 8% to 74%; P <0.001)”
That’s only a mean 1.3% regression compared to the 2.2% regression seen in the Ornish study, and the rosuvastatin study was done over a TWO year period as opposed to the ONE year Ornish study (so it’s possible the difference would have doubled if Ornish trial were extended to two years).
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Did you see Bicep 's data above? The LM clearly went from a calcium score of 247 all the way to zero in 4 measurements taken over a 3 year period. I’m mystified by it.
My father is vegetarian, does OMAD, goes to the gym regularly, gardens, and leads a very healthy lifestyle. Yet his ApoB was 120 and LDL was 130.
He needed Bempedoic Acid and Ezetemibe to bring both down to the mid 60s. He couldn’t do it alone with lifestyle. At some point you need help from medicine.
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I’m not surprised that a plant-based diet low in (saturated) fat and high in fiber alongside exercise helps with various conditions.
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AnUser
#67
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.
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The best bit was when he shit all over resveratrol
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AnUser
#69
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
#70
Do you think this is meaningful or meaningless? Or do you think the results are not real?
AnUser
#71
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.
AnUser
#73
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.
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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
#75
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.
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.
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!
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AnUser
#77
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
Your CAC has also increased over time…
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AnUser
#78
50% of fatal MI’s occur in non-calcified areas of coronary arteries.
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Where are you getting this “minimum diameter” criterion from? Is it from CCTA, which wasn’t available at the time of the Ornish study?
From where are you getting these numbers?
AnUser
#80
It’s in the Ornish study.
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.
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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.
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