In 1985, I initiated a small study utilizing WFPBN in 24 patients who were severely ill with CAD. The moment of truth came a year later for a patient in his 50s with significant vascular disease in his heart and right leg. At study onset, while crossing a skyway into the Cleveland Clinic he experienced claudication that forced him to stop and rest five times. Results of a pulse volume study revealed a markedly diminished right ankle pulse. Following nine months of WFPBN, all claudication had resolved, and a repeat pulse volume was double that of his baseline.^[11] As statin drugs were not yet available, this was proof of the concept that WFPBN alone can halt and reverse CVD.

After 12 years, we reviewed the CVD events of our 18 adherent patients. During the eight years prior to entering our study, while in the care of expert cardiologists, they had sustained 49 cardiac events, which was indicative of disease progression. In contrast, 17 of the 18 patients sustained no further events during the 12 years they spent in our study. One patient who was initially adherent developed angina and required bypass surgery six years after resuming a Western diet. These findings illustrate the need for close adherence with WFPBN.^[12]

Twelve patients in our initial group had a follow-up angiogram. There was significant disease reversal in four of them, which suggests that WFPBN could not only eliminate future cardiac events but could also reverse angiographic disease. Even if significant angiographic reversal does not occur, patients can still benefit from more subtle improvements in the overall health of their endothelial cells and their capacity to produce nitric oxide, eliminating angina and future CVD events.^[12] Additionally, the robust antioxidant value of WFPBN diminishes oxidative inflammation in plaques and foam cells, thus strengthening the cap over the plaques (Figure 1).

(Figure 1) Progressive plaque cap thickening (white arrow) and plaque shrinkage accomplished with plant-based nutrition.

In 2014, we conducted a second larger study of 198 patients with significant CAD.^[9] Of these patients, 119 had undergone a prior coronary intervention with stents or bypass surgery, and 44 had a previous heart attack. There were multiple comorbidities including hypercholesterolemia, hypertension, obesity, and diabetes. During four years of follow up, 99.4% of the participants who adhered to WFPBN avoided any major cardiac event including heart attack, stroke, and death, and angina improved or resolved in 93%. Of the 21 non-adherent participants, 13 (62%) experienced an adverse event. When comparing these results to the well-known COURAGE,^[13] and Lyon Diet Heart Study,^[14] which consisted of conventionally treated participants, there is beyond a 30-fold difference in major cardiovascular events favoring WFPBN.