FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, November 27, 2024

A Holistic Approach to ASCVD:Summary of a Novel Framework and Report of 10 Case Studies

Richard Z. Cheng, M.D., Ph.D., Lei Duan, MBA, Tom E. Levy, M.D., J.D.

Abstract

Despite decades of intensive research and substantial investment in therapeutic development, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide. A key reason may be the significant limitations of the prevailing lipid-lowering approach in ASCVD management. While this approach may slow plaque progression, studies show only modest reductions in cardiovascular events and mortality. It generally fails to reverse existing plaque or address other critical factors like inflammation, oxidative stress, and insulin resistance, which are known drivers of ASCVD. Furthermore, statin side effects can affect patient compliance, and the "one-size-fits-all" model often overlooks individualized needs and essential lifestyle factors. Research suggests that LDL-cholesterol functions more as an intermediary mechanism rather than a root cause of ASCVD, with the limited progress in ASCVD outcomes likely due to an overemphasis on these intermediary factors rather than addressing the full array of root causes.

Our work re-analyzes known and emerging risk factors for ASCVD, categorizing them into root causes and intermediary mechanisms contributing to ASCVD (including coronary heart disease, carotid plaque, stroke, and peripheral artery disease). Based on this analysis, we developed a holistic approach focused primarily on root causes while also accounting for intermediary mechanisms.

In this first paper, we outline the limitations of current ASCVD management and introduce a novel, holistic framework that addresses both root causes and intermediary mechanisms. We also present 10 patient cases demonstrating significant improvement, including complete ASCVD reversal. Future papers in this series will delve deeper into root causes, intermediary mechanisms, and targeted clinical interventions.

Introduction

ASCVD remains the leading cause of mortality worldwide, despite significant advancements in prevention and treatment(1,2). While statins have been effective in lowering LDL cholesterol, their impact on reducing cardiovascular events and overall mortality has been less substantial than expected(3,4). This highlights a significant residual risk of cardiovascular events, even with optimal traditional risk factor management(2). Current treatment paradigms often fail to address root causes and intermediary mechanisms driving ASCVD development, such as chronic inflammation, oxidative stress, and metabolic dysfunction(5,6). There is a growing recognition of the need for a more holistic approach to ASCVD prevention and treatment, targeting multiple biological pathways and addressing both lipid levels and systemic inflammation(7,8).

LDL-cholesterol functions more as an intermediary mechanistic factor rather than a root cause of ASCVD.

Recent research challenges the traditional view of LDL-cholesterol as the primary cause of ASCVD. The effectiveness of statins in reducing ASCVD risk is also questioned, with some studies suggesting their benefits may be modest and not strongly mediated through LDL-cholesterol reduction(9–11). While some studies maintain that LDL-cholesterol causes ASCVD(12,13), others suggest it may be more of an intermediary mechanistic factor(9,14).

Recent research underscores the complex nature of ASCVD risk factors, extending beyond traditional markers. Lifestyle factors such as sedentary behavior, low-quality diet, and psychosocial stress play significant roles in elevating ASCVD risk(15,16). Dietary patterns high in carbohydrate(17–22), ultra-processed foods(23–29), and high omega-6 seed oils(30,31) have been associated with increased ASCVD risks. Hormonal imbalances significantly contribute to the risk of atherosclerotic cardiovascular disease(32–36). A recent study underscores the importance of inflammation in ASCVD risk, demonstrating that chronic inflammation, alongside lipoprotein(a) and cholesterol levels, is significantly associated with long-term cardiovascular outcomes in women(14). One of us (TEL) has extensively argued that inflammation is a fundamental root cause in the development and progression of atherosclerotic cardiovascular disease (ASCVD)(37–41).

Linus Pauling’s unifying theory of atherosclerotic cardiovascular disease (ASCVD) proposed decades ago offers an alternative to the traditional view that LDL-cholesterol is the primary cause of ASCVD(42). Pauling argued that ASCVD is driven more by nutrient deficiencies—particularly in vitamin C—which weaken arterial walls, making them susceptible to damage. In this scenario, lipoproteins, including lipoprotein(a), act as a vascular “repair” mechanism rather than as the root cause. This perspective aligns with recent research that challenges the role of LDL-cholesterol as the primary culprit in ASCVD, suggesting instead that it functions more as an intermediary mechanism in the disease process.

These findings indicate a need for a more comprehensive approach to understanding and assessing ASCVD risk.

There is an urgent need for earlier and holistic approaches to effectively prevent ASCVD and its complications(8). This paradigm shift emphasizes comprehensive risk assessment and integrative management starting earlier in life.

This series of papers will explore the limitations of the current ASCVD management paradigm and propose a novel, holistic approach that addresses not only symptoms but, more importantly, the underlying root causes of ASCVD. By incorporating lifestyle modifications such as dietary interventions, targeted supplementation, identification, prevention, and detoxification of environmental toxins, and hormonal balancing when necessary, this approach aims to reduce cardiovascular event risk while enhancing overall metabolic health.

Key Limitations of the Current Paradigm:

1. Overemphasis on LDL Cholesterol: Cholesterol is treated as the central player in ASCVD, while other factors like chronic inflammation, endothelial dysfunction, insulin resistance and oxidative stress are not adequately addressed.
2. Neglect of Root Causes: Poor dietary choices, environmental toxins, insulin resistance, and metabolic imbalances contribute significantly to the development of ASCVD, yet they remain under-recognized in standard treatment.
3. Pharmacological Dependence: While statins and other drugs reduce LDL levels, they do not fully resolve the underlying mechanisms driving cardiovascular disease.

A Novel Holistic Approach to ASCVD

To improve ASCVD outcomes, we propose a holistic framework based on addressing the root causes, targeting the intermediary mechanisms, and preventing the final outcomes such as plaque formation and cardiovascular events.

Core Elements of the Holistic Approach:

• Dietary Interventions: A low-carbohydrate, anti-inflammatory diet rich in nutrition and healthy fats, such as the low carb ketogenic diet, can reduce insulin resistance, inflammation, and oxidative stress.
• Targeting Inflammation and Oxidative Stress: Integrative strategies including healthy lifestyle and proper nutrition supplements such as vitamins and antioxidants (vitamins Bs, C, D, E and K2), omega-3 fatty acids, magnesium, selenium, and play a crucial role in reducing the intermediary mechanisms of disease progression.
• Identification and removal of existing chronic inflammatory foci, especially oral and dental inflammations are of paramount importance(40,43–49).
• Metabolic and Hormonal Health: Addressing insulin sensitivity through dietary and exercise interventions, and hormonal balance if necessary, improves metabolic health, which is essential in preventing ASCVD.
• Environmental Detoxification: Heavy metals, pesticides, and other environmental toxins contribute to oxidative stress and inflammation. A structured detoxification protocol helps reduce the burden on the cardiovascular system.
• Exercise and Stress Management: Physical activity, stress reduction techniques, and mental health support are key components for improving overall cardiovascular health.

A Report of 10 Cases of Successful ASCVD Reversal

To further illustrate the effectiveness of this holistic approach, we present 10 case studies where patients successfully reversed their ASCVD diagnosis through integrative methods. These cases highlight the critical role of addressing diet, lifestyle, and metabolic health in reversing cardiovascular disease.

Case #1 (#ZSXQ186): Complete reversal of coronary stenosis

A 62-year-old man with a history of symptomatic coronary artery disease (CAD) showed a complete reversal of his multi-site coronary stenosis after adopting our integrative orthomolecular medicine protocol (a low carb ketogenic diet, high dose vitamin C, omega-3 supplementation, other antioxidants and mitochondrial nutrients as well as regular exercise(50).

Prior to start our intervention, he had 2 CT-angiogram (CTA) exams ~5 months apart which showed that he had diffuse stenosis of his left anterior descending artery (LAD) which is responsible for ~50% of blood supply to the entire heart, ranging from mild (24-49% stenosis) in the proximal portion to moderate to severe (50-69 and up to 70-80%) of the mid portion LAD, as well as ~50% stenosis of her right coronary artery (RCA) stenosis, Figure1. We advised our Integrative Orthomolecular Medicine Protocol(1). Repeated CTA at 8 months showed significant reduction of stenosis and complete reversal (no stenosis seen anywhere in the coronary arteries) 18 months later.

Case #2 (#ZSXQ787): Complete reversal of coronary stenosis, lung nodules as well as significant reduction of facial age spots and the thyroid nodules.

A 64-year-old woman with coronary heart disease, characterized by significant coronary artery stenosis (60–70% stenosis) observed on repeated CTA scans in 2021 and 2022, as well as pulmonary and thyroid nodules, began our Integrative Orthomolecular Medicine Protocol for ASCVD. After one year on the program, a repeat CTA in July 2023 showed marked improvement in her coronary artery stenosis, with stenosis reduced to 1–24%. After two years, a follow-up CTA revealed complete resolution of the coronary artery stenosis (Figure 2a). Repeat chest CT scans also showed resolution of the pulmonary nodules, and ultrasounds indicated a reduction in both the size and number of thyroid nodules (data not shown). Additionally, her daughter noted a significant fading of a large, distinct age spot on her left cheek (Figure 2b).

Figure 2b. Left: Oct. 2020; Center: Jul. 23rd, 2023; Right: Dec. 3rd, 2023. Notice the significant fading of the facial age spot.

Case #3 (#ZXSQ74): Reversal of carotid plaques

A 61-year-old man was diagnosed on October 6, 2020, with bilateral carotid artery plaque formation via ultrasound. After approximately six months on our integrative intervention, including a low-carb diet, orthomolecular nutrition, and bioidentical hormone balance (BHRT)(50), his overall condition improved significantly: on April 9, 2021, a carotid artery magnetic resonance angiography (MRA) showed no significant abnormalities. His other health problems (gallbladder wall thickening and roughness, signs of chronic cholecystitis) resolved, and Hashimoto's thyroiditis reversed, with antibodies turning negative.

Case #4 (#ZSXQ7110): Reversal of carotid plaques

A 67-year-old woman, diagnosed with 75% carotid artery stenosis. A repeat examination at the same hospital showed a significant reduction in carotid artery stenosis, decreasing from ~75% to 62%, after being on our integrative protocol for just 3 months, including low carb ketogenic diet, orthomolecular nutrition and BHRT(50). The patient stated: “I went to the same hospital for the checkup. The doctor couldn't believe it and thought I had met a miracle doctor or taken a miracle drug”.

Case #5 (#ZSXQ7784): Reversal of carotid intima-media thickness (CIMT) and osteopenia

A 55-year-old woman came to us in April 2022 with carotid intima-media thickness (CIMT) and osteopenia. We recommended our integrative protocol, including a low-carb ketogenic diet, orthomolecular nutrition, and liver detox. The patient followed our advice intermittently. However, despite the intermittent adherence, her carotid intima-media thickness (CIMT) completely resolved, and her bone density significantly improved over a two-year period, as evidenced by the reduction in T-scores on her DEXA scan (Figure 5a&b).

Case #6 (#GD-F001): Reversal of carotid plaque

A 61 years old woman with a history of bilateral carotid plaque formation came to our service. We placed her on our program of integrative orthomolecular emdicine protocol of primarlily low carb ketogenic diet and orthomolecular medicine. Eight months later, repeat ultrasound exam showed that her bilateral carotid/subclavian artery plaques disappeared (Figrue 6).

Case #7 (#ZSXQ6550): Reversal of carotid intima-media thickness (CIMT)

Dr. Z, 42 years old, male, also a practicing physician, verbally reported that his fatty liver improved from moderate to mild and his carotid intima-media thickness (CIMT) improved from 1.2 to 1.0 (data not shown).

Figure 7. “Dear Dr. Cheng, I have been following your advice and taking supplements. My fatty liver went from medium to mild and CIMT went from 1.2 5o 1.0 mm. Thank you very much for your instructions. I can’t find methylene blue on your website and I want 4 more bottles of methylene blue”.

Case #8 (#ZSXQ188): Reversal of carotid plaques

Mr. C, 68-year-old male, following an integrative approach including our dietary and nutritional supplements, found his carotid plaques gone in 3 years.

Case #9 (#ZSXQ10137): Reversal of carotid plaques

“My father has been on a low-carb ketogenic diet for more than a year and a half, without taking any medication or statins. Under the guidance of Dr. Cheng, he also received near-infrared irradiation and took about 15 grams of VC orally every day. Vit K2, Vit D3, potassium, magnesium, Vit B100, etc. were taken regularly. Comparison of carotid artery B-ultrasound on September 5, 2023 and July 20, 2024: The largest plaque on the left side went from about 2.5 cm down to 0. 5 cm, and the largest plaque on the right side went from about 4.3 cm to 0.4 cm. The thickness of the plaque on the right side changed from 75% stenosis of the lumen at the largest point to 50% stenosis at the largest point. I hope it can be completely reversed. Thank you very much for the advice of Dr. Richard Cheng”

Case #10: Reversal of varicose veins.

A 37-year-old man reversed his severe varicose veins over 8 months using vitamin C as part of our integrative orthomolecular medicine program. Although varicose veins are not part of ASCVD, they are also a condition involving blood vessel structural integrity. Vitamin C plays a critical role in supporting collagen synthesis, which is essential for maintaining vascular strength and resilience.

Figure 10. Significant change of his varicose veins of his left leg after being on our integrative approach for 8 months.

Conclusion

The conventional ASCVD management paradigm, primarily focused on lowering cholesterol, has proven insufficient in meaningfully reducing the cardiovascular disease burden. This paper introduces a holistic approach that addresses the root causes, intermediary mechanisms, and final outcomes of ASCVD, offering a more effective and sustainable solution. The case studies presented demonstrate the potential of this integrative framework to not only manage but also reverse ASCVD, significantly enhancing overall cardiovascular health. Future papers in this series will delve further into the specific strategies and interventions that define this innovative approach to ASCVD management.

Shared Root Causes and Intermediary Mechanisms Across Diseases

Many chronic diseases, including ASCVD, share common root causes and intermediary mechanisms, such as oxidative stress, inflammation, and impaired cellular repair. Addressing these foundational factors can lead to improvements across multiple conditions, as demonstrated in our case studies.

For example, in Case #2, the patient not only experienced a complete reversal of 70% coronary stenosis but also saw significant improvements in other areas, including resolution of lung and thyroid nodules and the fading of a facial age spot. Similarly, in Case #10, varicose veins were also reversed using this integrative approach. These multi-faceted recoveries underscore the power of targeting root causes rather than merely addressing symptoms.

In traditional Chinese medicine, this approach is known as "Treating Different Diseases with the Same Treatment" (异病同治). By focusing on shared underlying mechanisms, we can promote healing across multiple systems, achieving broader and more comprehensive health outcomes. This integrative strategy reinforces the interconnectivity of bodily systems and highlights the potential of a holistic, root-cause-focused approach to improving outcomes across a range of chronic conditions.

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