{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T19:27:39Z","timestamp":1770233259179,"version":"3.49.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 43-year-old man with Class III obesity (BMI 43.8\u2005kg\/m\u00b2), 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\u2005cm, BP 185\/100 mmHg, visceral fat \u223c40%, LDL 1.51\u2005mmol\/L, HDL 0.97\u2005mmol\/L, HbA1c 5.3%, stress METS 6.3 without ischemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>The patient lost 50\u2005kg (41% of baseline) with BMI 25.8\u2005kg\/m\u00b2, waist 85\u2005cm, visceral fat 12%. Functional capacity improved (METS 6.30\u201311.5), HDL increased (0.97\u20131.63\u2005mmol\/L), HbA1c decreased (5.3%\u20134.9%), and blood pressure improved (185\/100 to 140\/85\u2005mmHg). However, LDL and total cholesterol rose (LDL 1.51\u20133.44\u2005mmol\/L; total cholesterol 3.32\u20135.47\u2005mmol\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1737431","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:47:13Z","timestamp":1770187633000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"13","author":[{"given":"Reynard","family":"Laysandro","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia \u2013 Dr. Cipto Mangunkusumo General Hospital","place":["Jakarta, Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elbert 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