Is It Possible to Reverse Atherosclerosis?

Learn about atherosclerosis reversal: what’s possible, what isn’t, and evidence-based strategies to manage plaque buildup.

By Medha deb

Created on Sep 26, 2025

Learn about atherosclerosis reversal: what’s possible, what isn’t, and evidence-based strategies to manage plaque buildup.

Atherosclerosis—often referred to as the hardening or narrowing of the arteries due to plaque buildup—remains a leading cause of heart attack and stroke worldwide. As science advances, many wonder: Can atherosclerosis be reversed, or is lifelong management the best we can hope for? Here, we review the current evidence, expert opinions, and practical strategies for managing and potentially reversing this complex condition.

Understanding Atherosclerosis

Atherosclerosis occurs when fatty substances, cholesterol, calcium, and other materials build up inside artery walls, forming plaques. These plaques stiffen and narrow arteries, restricting blood flow and putting you at higher risk for cardiovascular events.

Plaque buildup develops over years and can start as early as childhood.
Main contributors include high LDL cholesterol, hypertension, smoking, diabetes, and a sedentary lifestyle.
Advanced atherosclerosis can result in heart attacks, strokes, peripheral artery disease, and chronic kidney disease.

Key Terms to Know

LDL Cholesterol (Low-Density Lipoprotein): Often called “bad” cholesterol, it plays a major role in plaque formation.
HDL Cholesterol (High-Density Lipoprotein): The “good” cholesterol, which helps remove LDL cholesterol from arteries.
ApoB Lipoproteins: Proteins responsible for packaging cholesterol and a central factor in developing arterial plaques.

Can Atherosclerosis Be Reversed?

The idea of reversing atherosclerosis is compelling. However, the answer depends on stage of disease and type of intervention. Let’s review the main possibilities based on current research:

Approach	Evidence of Plaque Reversal	Practical Considerations
Extreme Lifestyle Change (e.g., Ornish Diet)	Modest plaque shrinkage seen in small studies.	Difficult to sustain for many; most improvement in early stages.
Intensive Lipid Lowering (statins, PCSK9 inhibitors)	Some regression in plaque, especially early in disease.	Lifelong adherence and regular monitoring required.
Surgical Interventions	Removes or bypasses blockages, not underlying disease.	Treats symptoms, but plaques may build up elsewhere.
Conventional Lifestyle & Medication	Slows or halts progression; reversal less likely in advanced cases.	Accessible and recommended for most patients.

Major Points

Complete reversal of atherosclerosis is rarely achieved, especially in advanced cases.
Early intervention and aggressive risk factor reduction may allow for regression or stabilization of plaque.
Even when plaque isn’t completely removed, therapies can stabilize it, reducing the risk of heart attack and stroke.

How Do Doctors Assess Atherosclerosis?

Doctors diagnose and monitor atherosclerosis using several tools:

Blood tests (to check cholesterol, glucose, and markers of inflammation)
Imaging studies (such as coronary artery calcium scans, CT angiography, or ultrasound)
Stress testing (to evaluate blood flow under physical exertion)

Regular assessment is vital for tracking progression and response to treatment.

What Research Shows About Reversing Plaque

Evidence from Lifestyle Intervention Trials

Some small studies—most notably by Dr. Dean Ornish—found that comprehensive lifestyle changes could lead to a modest reduction in plaque size in certain individuals. His program combines:

A mostly vegetarian diet delivering under 10% of calories from fat and very low cholesterol
Regular aerobic exercise
Stress management (such as yoga and meditation)
Group/social support

Over years, those who stuck with these habits saw small but meaningful reductions in arterial plaque compared to control groups, who experienced progression. However, these changes are hard to sustain and not suitable for everyone. Most consistent benefits were seen in early or moderate stages of atherosclerosis.

Drug Approaches: Statins and PCSK9 Inhibitors

Powerful lipid-lowering medications—statins and newer drugs like PCSK9 inhibitors—can not only slow plaque growth, but sometimes slightly shrink plaque in early cases. Their main benefit, though, is in making plaques more stable, less likely to rupture, and much safer.

Statins: Lower LDL cholesterol substantially, reduce inflammation, and make plaques more fibrous and less prone to rupture—even if the overall plaque volume doesn’t decrease much.
PCSK9 Inhibitors: Further reduce LDL cholesterol, often used for high-risk patients or those with genetic hypercholesterolemia.

Recent research suggests that intensive, early LDL reduction may allow some regression of early-stage atherosclerosis. The impact of lifelong low cholesterol is particularly substantial in preventing future cardiovascular events.

Why Can’t All Plaque Be Removed?

Once established, plaque contains not just fat, but also calcium and scar tissue, making it difficult to remove completely.
Medical and lifestyle therapies may shrink the fatty portion, but fibrous and calcified parts remain even in the best cases.
The main clinical goal is stabilizing existing plaque and preventing new plaque formation.

Effective Strategies to Manage and Reverse Atherosclerosis Progression

While many treatments aim to halt or delay progression, the following strategies may give the best chance of partial regression, especially if started early:

1. Lifestyle Changes

Eat a heart-healthy diet: Focus on plenty of vegetables, fruits, whole grains, legumes, nuts, seeds, lean protein, and healthy fats (such as from olive oil and fatty fish). Limit saturated and trans fats, added sugar, and excess salt.
Exercise regularly: Aim for at least 150–300 minutes/week of moderate aerobic activity, plus some strength training.
Stop smoking: Quitting tobacco products is one of the most powerful ways to slow and potentially reverse early plaque buildup.
Manage stress: Techniques like meditation, deep breathing, and social support may improve heart health markers.
Maintain a healthy weight: Even modest weight loss can significantly benefit blood pressure, cholesterol, and metabolic health.

2. Medications

Statins: First-line for most patients with atherosclerosis or high cardiovascular risk.
PCSK9 inhibitors: Used in addition to statins in select high-risk individuals.
Other cholesterol-lowering drugs: Fibrates, bile acid sequestrants, ezetimibe, and niacin may be used where appropriate.
Medications for hypertension and diabetes: Keeping blood pressure and blood sugar under tight control further lowers risk.
Low-dose aspirin: Sometimes used for secondary prevention in patients with a history of heart attack or stroke, but only under medical advice.

3. Surgical and Interventional Procedures

Angioplasty and stenting: Open up significant blockages to restore blood flow, but do not remove underlying disease.
Coronary artery bypass grafting (CABG): Reroutes blood around severe blockages; used in advanced cases.

These interventions are reserved for those with significant symptoms or advanced disease and are considered treatments of last resort for risk reduction.

The Role of Early and Intensive Treatment

Mounting evidence indicates that aggressive risk factor management early in life provides the biggest gains in reducing plaque and preventing cardiovascular events. The earlier LDL cholesterol and other risk factors are brought under control, the less chance there is for dangerous plaques to form and mature. Recent clinical trials are now exploring whether short-term intensive lowering of atherogenic lipoproteins in young and middle-aged adults could eradicate early plaques and potentially prevent clinical heart disease altogether.

Frequently Asked Questions About Atherosclerosis and Reversal

Can atherosclerosis be cured?

Currently, atherosclerosis cannot be completely cured, especially once plaque has matured. However, aggressive risk reduction and lifestyle changes can halt progression, sometimes modestly reverse early stages, and greatly reduce the risk of complications.

Is it ever too late to make a difference?

It’s never too late to adopt healthier habits—many studies show that even late interventions meaningfully reduce the risk of heart attack and stroke. Younger patients see the most dramatic benefits from early intervention and prevention.

What’s the best diet to reverse atherosclerosis?

The best-supported evidence comes from plant-based or Mediterranean-style eating patterns that emphasize fiber, antioxidants, healthy fats, and low saturated fat intake. Strict vegan or ultra-low-fat diets may offer incremental benefit for highly motivated individuals.

What symptoms does atherosclerosis cause?

Early atherosclerosis often causes no symptoms. As plaques grow, symptoms may include chest pain (angina), leg pain with walking, numbness or weakness, and—tragically—heart attack or stroke if plaque ruptures and blocks blood flow.

Can exercise reverse plaque buildup?

Regular aerobic exercise improves blood vessel health, lowers many risk factors, and may help slow or even slightly regress plaque in early disease. However, exercise is most effective when combined with diet, medication, and no smoking.

Takeaway: What’s Possible Now

Atherosclerosis is a chronic process, but with early and sustained lifestyle changes, along with appropriate medical therapy, many patients can slow or modestly reverse early plaque buildup. Importantly, stabilizing existing plaque significantly decreases your risk of heart attack and stroke. For most people, the greatest power lies in prevention, aggressive risk factor management, and regular follow-up with a healthcare provider.

References & Further Reading

American Heart Association: Lifestyle and dietary recommendations
Recent trials on statins, PCSK9 inhibitors, and newer treatment strategies
Expert consensus guidelines on cardiovascular risk reduction

FAQs

Q: Are there any diets proven to reverse atherosclerosis?

Some evidence supports very low-fat, plant-based diets for mild regression in early disease, but most diets focus on slowing progression and improving cardiovascular risk factors overall.

Q: Will all patients benefit equally from aggressive cholesterol lowering?

Patients with early or moderate disease and those at highest cardiovascular risk tend to benefit most from intensive lipid lowering. Therapy should be individualized.

Q: How do statins help if they don’t remove plaque?

Statins stabilize the plaque’s surface and reduce inflammation, making rupture—and therefore heart attack or stroke—much less likely, even if plaque size changes little.

Q: What role does inflammation play in atherosclerosis?

Inflammation is central in both the development and progression of atherosclerosis. Emerging therapies targeting inflammation offer hope for future treatment options.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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