Can diet and weight loss reverse carotid atherosclerosis?

January 01, 0001

Can diet and weight loss reverse carotid atherosclerosis?

Carotid atherosclerosis is a costly disease with significant sequelae, including stroke. An international group of researchers tested whether dietary weight loss interventions induce regression of carotid atherosclerosis. They administered the Dietary Intervention Randomized Controlled Trial-Carotid (DIRECT-Carotid) study, a two year study where participants were randomized to low-fat, Mediterranean, or low-carbohydrate diets and were followed for changes in ultrasound measured carotid artery intima-media thickness and carotid vessel wall volume (VWV).

The researchers report: "Of 140 complete images of participants (aged 51 years, body mass index 30 kg/m2, 88% men), higher baseline carotid VWV was associated with increased intima-media thickness, age, male sex, baseline weight, blood pressure, and insulin levels. After 2 years of dietary intervention, we observed a significant 5% regression in mean carotid VWV (-58.1 mm3), with no differences in the low-fat, Mediterranean, or low- carbohydrate groups (-60.69 mm3, -37.69 mm3, -84.33 mm3, respectively). Mean change in intima-media thickness was -1.1%. A reduction in the ratio of apolipoprotein B100 to apolipoprotein A1 was observed in the low-carbohydrate compared with the low-fat group. Participants who exhibited carotid VWV regression (mean decrease, -128.0 mm3) compared with participants who exhibited progression (mean increase, +89.6 mm3) had achieved greater weight loss (-5.3 versus -3.2 kg), greater decreases in systolic blood pressure (-6.8 versus -1.1 mm Hg) and total homocysteine (-0.06 versus +1.44 µmol/L), and a higher increase of apolipoprotein A1 (+0.05 versus -0.00 g/L). In multivariate regression models, only the decrease in systolic blood pressure remained a significant independent modifiable predictor of subsequent greater regression in both carotid VWV (Beta=0.23) and intima-media thickness (Beta=0.28) levels."

The authors concluded: "Two-year weight loss diets can induce a significant regression of measurable carotid VWV. The effect is similar in low- fat, Mediterranean, or low-carbohydrate strategies and appears to be mediated mainly by the weight loss-induced decline in blood pressure."

This study yielded the promising finding that weight loss led to improvements in ultrasound findings for carotid atherosclerosis, though it remains to be seen whether there is further clinical benefits.

For the full abstract, click here.

Circulation 121:1200-1208, March 2010
© 2010 American Heart Association, Inc.
Dietary Intervention to Reverse Carotid Atherosclerosis. Iris Shai, J. David Spence, Dan Schwarzfuchs, et al. Correspondence to Iris Shai: [email protected]

Category: K. Circulatory, T. Endocrine/Metabolic/Nutritional. Keywords: weight loss, diet, hypertension, carotid atherosclerosis, DIRECT- carotid study, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 9 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.