Angina rapidly improved with a plant-based diet and returned after resuming a Western diet

Atherosclerosis and its related cardiovascular disease is the most common cause of morbidity and mortality in the Western world. The roots of this disease may lie, in part, in dietary and lifestyle behaviors, indicating that modification of these behaviors may lead to profound improvements.  A 77-year-old woman presented with unstable angina. Her past medical history included hypertension, hyperlipidemia and remote tobacco use for which she had been treated with atenolol 50 mg daily and simvastatin 20 mg daily. At her baseline, she could walk more than half a mile without complaints. Over the two to three months prior to presenting, she developed gradually worsening chest pressure and shortness of breath to the point where she was unable to walk more than half of a city block or up one flight of stairs. Her symptoms resolved with rest. Coronary angiography revealed severe three-vessel disease, and a referral for coronary artery bypass graft surgery (CABG) was made. Her left ventricular size and function were normal on echocardiography. Daily aspirin 81 mg and sublingual nitroglycerin as needed were added to her medication regimen. The patient chose, however, to not proceed with surgery and rather she chose to adopt a whole-food plant-based diet, which included all vegetables, fruits, whole grains, potatoes, beans, legumes and nuts. She eliminated all animal derived products, such as eggs, cow’s milk, yoghurt, chicken and beef, and she presented to our cardiac wellness program. She described her previous diet as a ‘healthy’ Western one. Clopidogrel 75 mg daily was added to her medical regimen, simvastatin was replaced by a high-potency statin (atorvastatin 80 mg daily) and atenolol was replaced by carvedilol. Within one month of lifestyle change her symptoms had nearly resolved, and she was able to walk on a treadmill for up to 50 min without chest discomfort or