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.

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.