How a Plant-Based Diet and Ultra-Low LDL Levels Can Reverse Atherosclerosis and Prevent Restenosis: A Breakthrough in Heart Health

Dasaad Mulijono*

Dasaad Mulijono*

Volume6-Issue4
Dates: Received: 2025-04-08 | Accepted: 2025-04-23 | Published: 2025-04-24
Pages: 368-372

Abstract

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.

FullText HTML FullText PDF DOI: 10.37871/jbres2091

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How to cite this article

Mulijono D. How a Plant-Based Diet and Ultra-Low LDL Levels Can Reverse Atherosclerosis and Prevent Restenosis: A Breakthrough in Heart Health. J Biomed Res Environ Sci. 2025 Apr 24; 6(4): 368-372. doi: 10.37871/jbres2091, Article ID: JBRES2091, Available at: https://www.jelsciences.com/articles/jbres2091.pdf

Subject area(s)

Vascular Medicine

Nutrition

Clinical Cardiology

References

Rivera FB, Cha SW, Varona MC, Fernandez Co EM, Magalong JV, Aparece JP, De Oliveira-Gomes D, Kaur G, Gulati M. Atherosclerotic coronary plaque regression from lipid-lowering therapies: A meta-analysis and meta-regression. Am J Prev Cardiol. 2024 Mar 11;18:100645. doi: 10.1016/j.ajpc.2024.100645. PMID: 38550634; PMCID: PMC10966153.
Dawson LP, Lum M, Nerleker N, Nicholls SJ, Layland J. Coronary Atherosclerotic Plaque Regression: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Jan 4;79(1):66-82. doi: 10.1016/j.jacc.2021.10.035. PMID: 34991791.
Yamawaki T, Yamada A, Fukumoto Y, Kishi T, Sobashima A, Kuwata K, Nakamura R, Sekiya M, Ando H, Okamatsu S. Statin therapy may prevent restenosis after successful coronary intervention, independent of lipid-lowering effect and CRP level. Fukuoka Igaku Zasshi. 2007 Jun;98(6):260-9. PMID: 17665547.
Ryu JC, Bae JH, Ha SH, Kwon B, Song Y, Lee DH, Kim BJ, Kang DW, Kwon SU, Kim JS, Chang JY. Association between lipid profile changes and risk of in-stent restenosis in ischemic stroke patients with intracranial stenosis: A retrospective cohort study. PLoS One. 2023 May 10;18(5):e0284749. doi: 10.1371/journal.pone.0284749. PMID: 37163551; PMCID: PMC10171672.
Iwata A, Miura S, Shirai K, Kawamura A, Tomita S, Matsuo Y, Zhang B, Nishikawa H, Kumagai K, Matsuo K, Saku K. Lower level of low-density lipoprotein cholesterol by statin prevents progression of coronary restenosis after successful stenting in acute myocardial infarction. Intern Med. 2006;45(15):885-90. doi: 10.2169/internalmedicine.45.1757. Epub 2006 Sep 1. PMID: 16946569.
Grundy SM, Feingold KR. Guidelines for the Management of High Blood Cholesterol. [Updated 2022 May 28]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
Raymond C, Cho L, Rocco M, Hazen SL. New cholesterol guidelines: worth the wait? Cleve Clin J Med. 2014 Jan;81(1):11-9. doi: 10.3949/ccjm.81a.13161. PMID: 24391101; PMCID: PMC4019214.
Sinning D, Landmesser U. ESC-Leitlinien 2016 – Dyslipidämien [ECS guidelines 2016 - dyslipidaemias]. Herz. 2016 Dec;41(8):671-676. German. doi: 10.1007/s00059-016-4505-6. PMID: 27844136.
Raygor V, Khera A. New Recommendations and Revised Concepts in Recent Guidelines on the Management of Dyslipidemias to Prevent Cardiovascular Disease: the 2018 ACC/AHA and 2019 ESC/EAS Guidelines. Curr Cardiol Rep. 2020 Jul 9;22(9):87. doi: 10.1007/s11886-020-01331-z. PMID: 32647997.
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021 Sep 7;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484. Erratum in: Eur Heart J. 2022 Nov 7;43(42):4468. doi: 10.1093/eurheartj/ehac458. PMID: 34458905.
Writing Committee; Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Covington AM, DePalma SM, Minissian MB, Orringer CE, Smith SC Jr, Waring AA, Wilkins JT. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022 Oct 4;80(14):1366-1418. doi: 10.1016/j.jacc.2022.07.006. Epub 2022 Aug 25. Erratum in: J Am Coll Cardiol. 2023 Jan 3;81(1):104. doi: 10.1016/j.jacc.2022.11.016. PMID: 36031461.
Aygun S, Tokgozoglu L. Comparison of Current International Guidelines for the Management of Dyslipidemia. J Clin Med. 2022 Dec 6;11(23):7249. doi: 10.3390/jcm11237249. PMID: 36498823; PMCID: PMC9737468.
Braunwald E. Cholesterol: the race to the bottom. Eur Heart J. 2021 Dec 1;42(45):4612-4613. doi: 10.1093/eurheartj/ehab446. PMID: 34339502.
Braunwald E. How to live to 100 before developing clinical coronary artery disease: a suggestion. Eur Heart J. 2022 Jan 31;43(4):249-250. doi: 10.1093/eurheartj/ehab532. PMID: 34355758.
Gibbons GH, Seidman CE, Topol EJ. Conquering Atherosclerotic Cardiovascular Disease - 50 Years of Progress. N Engl J Med. 2021 Mar 4;384(9):785-788. doi: 10.1056/NEJMp2033115. Epub 2021 Feb 27. PMID: 33657686.
Jeswani BM, Sharma S, Rathore SS, Nazir A, Bhatheja R, Kapoor K. PCSK9 Inhibitors: The Evolving Future. Health Sci Rep. 2024 Oct 30;7(11):e70174. doi: 10.1002/hsr2.70174. PMID: 39479289; PMCID: PMC11522611.
Rodriguez F, Khera A. How Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention. Circulation. 2023 Apr 18;147(16):1204-1207. doi: 10.1161/CIRCULATIONAHA.123.064041. Epub 2023 Apr 17. PMID: 37068134; PMCID: PMC10281650.
Karagiannis AD, Mehta A, Dhindsa DS, Virani SS, Orringer CE, Blumenthal RS, Stone NJ, Sperling LS. How low is safe? The frontier of very low (<30 mg/dL) LDL cholesterol. Eur Heart J. 2021 Jun 7;42(22):2154-2169. doi: 10.1093/eurheartj/ehaa1080. PMID: 33463677.
Bandyopadhyay D, Qureshi A, Ghosh S, Ashish K, Heise LR, Hajra A, Ghosh RK. Safety and Efficacy of Extremely Low LDL-Cholesterol Levels and Its Prospects in Hyperlipidemia Management. J Lipids. 2018 Apr 23;2018:8598054. doi: 10.1155/2018/8598054. PMID: 29850255; PMCID: PMC5937425.
Patti G, Spinoni EG, Grisafi L, Mehran R, Mennuni M. Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials. Eur Heart J Cardiovasc Pharmacother. 2023 Feb 2;9(2):138-147. doi: 10.1093/ehjcvp/pvac049. PMID: 36102667.
Makover ME, Shapiro MD, Toth PP. There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness. Am J Prev Cardiol. 2022 Aug 6;12:100371. doi: 10.1016/j.ajpc.2022.100371. PMID: 36124049; PMCID: PMC9482082.
Marston NA, Giugliano RP, Park JG, Ruzza A, Sever PS, Keech AC, Sabatine MS. Cardiovascular Benefit of Lowering Low-Density Lipoprotein Cholesterol Below 40 mg/dL. Circulation. 2021 Nov 23;144(21):1732-1734. doi: 10.1161/CIRCULATIONAHA.121.056536. Epub 2021 Aug 27. PMID: 34452583; PMCID: PMC8608715.
Papafaklis MI, Koros R, Tsigkas G, Karanasos A, Moulias A, Davlouros P. Reversal of Atherosclerotic Plaque Growth and Vulnerability: Effects of Lipid-Modifying and Anti-Inflammatory Therapeutic Agents. Biomedicines. 2024 Oct 23;12(11):2435. doi: 10.3390/biomedicines12112435. PMID: 39595002; PMCID: PMC11591594.
Kayani T, Ahmad B, Chang RS, Qian F, Sahinoz M, Rehan MW, Giaimo A, Spatz ES, Hu J-R. Beyond Statins: Novel Lipid-Lowering Agents for Reducing Risk of Atherosclerotic Cardiovascular Disease. Pharmacoepidemiology. 2024;3(1):117-168. doi: 10.3390/pharma3010009
Bryniarski KL, den Dekker W, Legutko J, Gasior P, Tahon J, Diletti R, Wilschut JM, Nuis RJ, Daemen J, Kleczynski P, Van Mieghem NM, Jang IK. Role of Lipid-Lowering and Anti-Inflammatory Therapies on Plaque Stabilization. J Clin Med. 2024 May 25;13(11):3096. doi: 10.3390/jcm13113096. PMID: 38892807; PMCID: PMC11172633.
Sucato V, Ortello A, Comparato F, Novo G, Galassi AR. Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy. J Clin Med. 2024 Mar 25;13(7):1882. doi: 10.3390/jcm13071882. PMID: 38610647; PMCID: PMC11012834.
Agnello F, Ingala S, Laterra G, Scalia L, Barbanti M. Novel and Emerging LDL-C Lowering Strategies: A New Era of Dyslipidemia Management. J Clin Med. 2024 Feb 22;13(5):1251. doi: 10.3390/jcm13051251. PMID: 38592091; PMCID: PMC10931739.
Sarraju A, Nissen SE. Atherosclerotic plaque stabilization and regression: a review of clinical evidence. Nat Rev Cardiol. 2024 Jul;21(7):487-497. doi: 10.1038/s41569-023-00979-8. Epub 2024 Jan 4. PMID: 38177454.
Mulijono D, Hutapea AM, Lister INE, Sudaryo MK, and Umniyati H. Plant-Based Diet to Reverse/ Regress Vulnerable Plaque: A Case Report and Review. Archives of Clinical and Medical Case Reports. 2024;126-135. doi: 10.26502/acmcr.96550674
Mulijono D. Plant-Based Diet in Regressing/Stabilizing Vulnerable Plaques to Achieve Complete Revascularization. Archives of Clinical and Biomedical Research. 2024;236-244. doi: 10.26502/acbr.50170405
Mulijono D, Hutapea AM, Lister INE, Sudaryo MK, Umniyati H. Mechanisms Plant-Based Diets Reverse Atherosclerosis. Cardiology and Cardiovascular Medicine. 2024;290-302. doi: 10.26502/fccm.92920390.