Successful large caloric deficit with high protein modification diet and intensive aerobic and resistance training with progressive overload in adult patient with significant coronary artery disease: a case report
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…
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