Plant-Based Diet in Regressing/Stabilizing Vulnerable Plaques to Achieve Complete Revascularization

Author(s): Dasaad Mulijono

Coronary artery disease (CAD) has emerged as a significant concern in Indonesia, resulting in a substantial number of fatalities and illnesses. In the United States, the latest guidelines for managing patients with chronic coronary syndrome (CCS) have undergone significant changes, including the recommendation for conducting percutaneous coronary intervention (PCI) only for patients who continue to experience symptoms despite receiving optimal medical treatment (OMT). However, this approach may lead to increased morbidity and mortality due to the presence of vulnerable plaques (VPs). During coronary angiography, VPs are characterized by intermediate obstruction (40-70%) and normally do not produce ischemia during physiological studies. Determining the presence of VPs is crucial, even for asymptomatic individuals. Various methods can be employed to achieve this, with computed tomography coronary angiography (CTCA) being the most effective, practical, and cost-effective approach. To manage VPs, experts have recently utilized different techniques, either with stents or drug-coated balloons (DCB), demonstrating the safety and efficacy of these methods. Achieving complete revascularization (CR) in order to minimize the likelihood of future major adverse cardiac events (MACE) and mortality for patients with CCS is a significant challenge. One of the factors contributing to the inability to perform CR is the presence of VP. Both approaches, identifying and intervening in the vulnerable plaque, are difficult to implement in developing countries due to the lack of necessary tools and financial constraints. Studies have shown that plant-based diets (PBD) can reverse and stabilize VP, potentially leading to CR. PBD is an affordable and effective approach that requires healthcare providers skilled in educating and implementing this dietary approach with their patients. Hence, we introduce the most efficient, feasible, and costeffective solution for managing VP and avoiding MACE and mortality in CCS patients.