High CAC scores within the context of cardiovascular coronary disease reversal with diet and lifestyle changes

 Can a high CAC score remain in a person who has reversed heart disease and plaque levels with a low fat plant based diet and life style interventions? In other words are cardiovascular calcium deposits more resistant than plaque to reductions due to lifestyle and dietary interventions?

While a low-fat plant-based diet and lifestyle interventions can significantly improve cardiovascular health and reduce plaque, whether a high CAC score can remain despite these changes and whether calcium is more resistant to regression than plaque are complex questions:

 

1. Impact of Lifestyle Changes on Coronary Artery Disease (CAD):

• Positive Effects: Lifestyle interventions, including a healthy diet and exercise, are strongly associated with improvements in cholesterol, blood pressure, and overall heart health, and can reduce the risk of developing CAD. 
• Plaque Reduction: Studies have demonstrated that intensive lifestyle changes, including plant-based diets, can lead to a regression in the noncalcified component of plaque (the fibrofatty and necrotic core), which is the most vulnerable part of plaque. 
• Slower Progression: Evidence also suggests that healthy lifestyles can slow down the progression of coronary artery calcification. 

2. Calcified Plaque (CAC) and Reversibility:

• Calcium Progression vs. Regression: While lifestyle changes can slow the progression of calcification, there's less evidence to suggest they can significantly reverse the amount of calcium already present in the arteries. 
• Calcium and Plaque Vulnerability: Interestingly, studies have shown that increased calcification within plaque can actually stabilize it, making it less prone to rupture and potentially reducing the risk of future heart events, even if the overall calcium score remains high. 
• More Stable: Calcified plaques, though associated with higher CAC scores, are generally more stable and less likely to rupture than non-calcified plaques. 

3. Calcium vs. Non-calcified Plaque:

• Differential Response: Studies have shown that non-calcified plaques (the soft, fatty, more vulnerable part of the plaque) are more likely to regress with lifestyle and medical interventions than calcified plaques. 
• Mechanisms for Improvement: Lifestyle interventions are likely to have a stronger impact on reducing the lipid content of the plaques, which is a key component of non-calcified plaque, and may help stabilize or even reduce the overall plaque volume, though the calcified part might remain. 

In summary:

• A high CAC score does not necessarily indicate that you haven't achieved benefits from a plant-based diet and lifestyle interventions.
• While lifestyle changes can reduce plaque volume and stabilize plaque, already formed calcified deposits may not be reversed, or may regress less rapidly than the other parts of the plaque.
• Important: Improvements in overall cardiovascular health and reductions in non-calcified plaque are critical for reducing the risk of heart attacks and strokes, and should be the primary focus, even if CAC scores remain high.