Low-Density Lipoprotein Cholesterol (LDL-C) remains a key target in preventing and treating cardiovascular disease. Recent data and expert consensus increasingly support aggressive LDL-C lowering strategies, with emerging evidence suggesting that levels below 30 mg/dL (ultralow/ UL) may provide significant clinical benefits, including atherosclerosis regression and reduced rates of restenosis post-intervention.

At our cardiology centre at Bethsaida Hospital in Indonesia, directed by Prof. Dasaad Mulijono, we have successfully implemented a comprehensive approach that combines a Plant-Based Diet (PBD) with high-intensity lipid-lowering therapy (excluding PCSK9 inhibitors) to achieve sustained UL-LDL-C in patients with Coronary Artery Disease (CAD). This strategy has resulted in a restenosis rate of approximately 2%, compared to rates as high as 10-20% in other centres. Furthermore, Computed Tomography Coronary Angiography (CTCA), angiographic, and clinical follow-up data suggest signs of halted or regressed atherosclerotic progression.

These findings support the hypothesis that integrating a PBD with intensive lipid management may represent an effective and sustainable model for secondary prevention in high-risk cardiovascular populations. Future guidelines may consider more aggressive LDL-C targets and lifestyle-based interventions to optimize patient outcomes.