Front Cardiovasc Med. 2026 Feb 4;13:1737431. doi: 10.3389/fcvm.2026.1737431. eCollection 2026.
ABSTRACT
BACKGROUND: Lifestyle modification plays a central role in obesity and cardiometabolic disease management; however, its application in patients with obstructive coronary artery disease (CAD) is typically cautious due to safety concerns. Caloric restriction with a high protein diet and high-intensity exercise has not been well studied in this setting.
CASE PRESENTATION: A 43-year-old man with Class III obesity (BMI 43.8 kg/m²), uncontrolled hypertension and severe proximal LAD stenosis (CAD-RADS 4) presented with shortness of breath for evaluation. He declined percutaneous coronary intervention and chose structured intensive lifestyle therapy. Baseline data: waist 125 cm, BP 185/100 mmHg, visceral fat ∼40%, LDL 1.51 mmol/L, HDL 0.97 mmol/L, HbA1c 5.3%, stress METS 6.3 without ischemia.
MANAGEMENT: Under weekly multidisciplinary supervision (internal medicine, cardiology, nutrition, sports medicine), he followed progressive caloric restriction with a high protein diet and high-intensity aerobic plus resistance exercise over 10 months. Usual cardiovascular medical therapy was continued. Monitoring included vitals, ECG, electrolytes, lipids, and exercise tolerance.
OUTCOME: The patient lost 50 kg (41% of baseline) with BMI 25.8 kg/m², waist 85 cm, visceral fat 12%. Functional capacity improved (METS 6.30-11.5), HDL increased (0.97-1.63 mmol/L), HbA1c decreased (5.3%-4.9%), and blood pressure improved (185/100 to 140/85 mmHg). However, LDL and total cholesterol rose (LDL 1.51-3.44 mmol/L; total cholesterol 3.32-5.47 mmol/L). LDL rose consistent with fat mobilization physiology during diet and exercise. No arrhythmia or ischemic ECG changes were observed. The patient remained asymptomatic and entered maintenance training.
CONCLUSION: Extreme supervised lifestyle intervention may be feasible in carefully selected high-risk CAD patients. Standard moderate programs remain recommended; extreme strategies require intensive medical oversight.
PMID:41717581 | PMC:PMC12913545 | DOI:10.3389/fcvm.2026.1737431