You Can Reverse Heart Disease. So Why Aren’t We Talking About It?
A new era of cardiovascular care is possible—with help from nattokinase, a little-known enzyme found in fermented soybeans.
The Silent Crisis of Plaque Buildup
Ask most health experts what matters most for long-term wellness and prevention, and cardiovascular disease will land near the top. Heart attacks. Strokes. Cognitive decline. Kidney failure. The common denominator? Blood flow—or the lack of it.
Plaque accumulation in arteries is something we all face with age. It’s driven by hypertension, hyperlipidemia, lifestyle factors that include smoking, the standard American diet, and low physical activity, but also by lesser-known contributors, such as elevated lipoprotein(a). About 1 in 5 people have genetically high Lp(a), a potent and under-tested independent risk factor that often runs in families. And yet, most doctors don’t check for it.
Now here’s what most people don’t know: Arterial plaque can be reversed.
We’ve had evidence of this for over 25 years, but I’ve yet to read a cardiologist’s note that references plaque reversal as the goal.
A Breakthrough You Probably Haven’t Heard Of
In August 2023, a clinical study published in Frontiers in Cardiovascular Medicine examined the effects of nattokinase, an enzyme derived from natto, a traditional Japanese fermented soybean dish.
At a relatively high dose (10,800 FU per day), nattokinase reduced carotid artery plaque by an average of 22% over 12 months, as measured by CIMT, a non-invasive ultrasound technique used to assess the carotid arteries. The results were statistically robust (p < 0.0001) as part of a randomized and controlled trial, and the treatment was well-tolerated. The only element of caution was the potential for increased risk of bleeding for patients on blood thinners.
For context, the 2006 ASTEROID trial used the highest dose of the strongest statin, rosuvastatin (Crestor), and achieved 6.8% plaque regression over 24 months. Nattokinase showed a more dramatic level of improvement in half the time without the side effects of statins and at a fraction of the cost. So why isn’t this breakthrough part of prevention within traditional medicine?
Contrasting Nattokinase With Statins
Statins reduce cardiovascular risk by a variety of mechanisms quite different from nattokinase. They lower LDL, Apo B, and other forms of atherogenic cholesterol; have anti-inflammatory effects; and shift plaque to the hard, calcified form that is more stable and less likely to rupture. I often recommend statins in conjunction with nattokinase for individuals with moderate to high plaque levels, as their effects are complementary. If I had to choose between the two, I would pick Nattokinase, because plaque reversal is a higher priority. Thankfully, we don’t need to choose and can optimize prevention through an individualized approach. See my protocols at the end of this post for details.
My Call With Doctor Radio—and What They Didn’t Want to Discuss
There is a cardiology radio show on SiriusXM satellite radio, one of many programs on XM’s Doctor Radio channel. I listen here and there when I’m driving around because I want to keep up with mainstream medicine as much as I can. For months, I tried to call into the show, and finally, toward the end of May 2025, I was able to get on and pose my #1 question to Fred Feit, MD, the host, and his guest, another esteemed cardiologist, William O’Neill, MD. I asked if reversing arterial plaque was a goal in their clinical practices. Dr. O’Neill talked about stabilizing plaque and didn’t seem interested in the concept of reversal. They bantered back and forth but never really answered the question.
I mentioned the work of Dean Ornish, MD, assuming they were familiar with him, and then reviewed the details of the nattokinase study. Dr. Feit started to respond, and I tried to make one last point comparing it to the ASTEROID study (as described above), but he and Dr. O’Neill talked over me. Dr. Feit said he had never heard of nattokinase and was skeptical that it was that effective. He would have to look up the study himself, which was certainly reasonable. He asked Dr. O’Neill for his opinion, but Dr. O’Neill completely ignored the subject and instead began talking about angioplasty procedures.
Then my call was disconnected. Did the call drop by accident, or did Dr. Feit give the producer a silent signal, like a finger across the front of his neck, telling him to disconnect me? I’ll never know.
As is my nature, I didn’t accept their tepid and somewhat evasive responses. I emailed Dr. Feit and said I’d like to return to the show to discuss this important subject in more detail. To his credit, Dr. Feit reviewed the nattokinase study and emailed me back. He expressed skepticism, questioning its credibility, methodology, and plausibility. He emphasized that the results seemed exaggerated and stated that only a well-designed, double-blind, placebo-controlled trial would be convincing enough to merit serious consideration or publication in a major medical journal.
The study was controlled (with a population given a lower dose of nattokinase), and it reached high statistical significance. To me, the study has more than enough credibility and statistical power to be worthy of consideration, and I disagree that the results are not plausible. There have been many breakthroughs in my medical career that would never meet Dr. Feit’s criteria.
It remains more likely than not that nattokinase at an optimal dose will lead to that degree of plaque regression. A growing number of patients in my practice are getting baseline CIMT measurements, and most are taking nattokinase 10,000 FU in addition to diet, exercise, mindfulness, and other lifestyle interventions. Over time, I will be able to determine whether this protocol works by checking CIMT measurements annually. I will provide updates here on the effects of this protocol within my primary care practice.
The Heart Test I Had to Hunt Down for My Patients
We have an array of tools to assess cardiovascular health—stress tests, CT angiograms, coronary calcium scores—but few give precise measurements of total plaque burden. The exception? Carotid intima-media thickness (CIMT), a simple ultrasound test of the carotid arteries that captures both soft lipid-rich unstable plaque and hard calcified plaque.
CIMT is widely available, inexpensive, non-invasive, and radiation-free. Not many health care providers are even aware that this test exists. I first ordered a carotid ultrasound study, along with an additional request for CIMT measurements, back in September 2024. The radiologist assigned to read the ultrasound refused to do the CIMT measurements. I sent him a note for clarification, and his reply was that there was no solid medical rationale for adding this measurement. Additionally, he noted that this would be too great a burden on the vascular technicians. No medical rationale for checking arterial plaque width to get a baseline with the ultimate goal of reversing arterial disease? Interesting perspective.
I didn’t accept this rebuff either and spoke to the head administrator of Radiology to make sure it was okay with her. She said no problem, as long as the vascular techs were fine with it. So I called William and Ashley, the two techs. Both said it was simple to do and definitely not a burden for them. Done.
Here’s a protocol I believe could change everything:
1. Everyone over 40 should get a one-time lipoprotein(a) test in addition to the more standard metrics tested within Primary Care and Cardiology. We need to identify the 20% of people who have this independent risk factor for premature cardiovascular disease. Apolipoprotein B should be part of regular labs also, since this one value is an aggregate for all of the problematic, atherogenic forms of cholesterol.
2. Everyone over 50 should get a baseline CIMT scan to classify plaque burden:
Low: ≤ 0.7 mm
Medium: 0.8–1.2 mm
High: ≥ 1.3 mm
Then tailor treatment accordingly:
Low Plaque
Lifestyle optimization: diet, exercise, stress management, sleep, meditation, yoga, etc.
Consider nattokinase 10,000 FU/day based on individual factors
Retest CIMT every 2–3 years
Medium Plaque
Add nattokinase 10,000 FU/day
Aim for LDL < 70, ApoB < 80 through lifestyle interventions and medications like statins, Repatha, and sometimes ezetimibe (Zetia)
Retest CIMT every 1–2 years
High Plaque
Increase to nattokinase 20,000 FU/day twice a day
Intensify statin and other medication therapy if needed (LDL < 55, ApoB < 60)
Retest CIMT yearly
Imagine what could happen if we adopted this at scale. We could reduce the number of heart attacks, blood clots, and strokes. Lower the burden of dementia. Preserve kidney function. Extend lives—not just in years, but in quality.
Blood flow is everything. Let’s treat it like it is.
A Call to Action
I’ve spent years reading outside the margins, looking for better answers. The medical system is slow to change, especially when new data challenges the status quo or threatens entrenched economic interests. But that’s no excuse to ignore breakthroughs that could reshape public health.
Fantastic article and finally bringing to light the subject of the ability to reverse and not just prevent disease with nutrition and lifestyle. Enzymes are magic. Love the suggested protocol and testing suggestions. Thank you for the call to action!