Drugs to Treat Atherosclerosis
For millions of people at risk for atherosclerosis complications, lifestyle changes aren't enough. Fortunately, there are medications that can protect against atherosclerosis. Some can even partially reverse it.
Statins to Lower Bad Cholesterol
Statins are the best medications for lowering "bad" LDL cholesterol. They are also the most widely used cholesterol drugs. Statins cause LDL levels to fall by up to 60%. They also raise levels of HDL or "good" cholesterol. And they can help lower the level of triglycerides.
Taking a statin for a year or longer can even slightly shrink plaques that cause atherosclerosis. This reversal of atherosclerosis surprised many experts who believed it couldn’t be done.
Completely reversing it isn't possible yet. But taking a statin can reduce the risk of complications from atherosclerosis. For this reason, statins are often key to treating atherosclerosis.
Fibrates to Reduce Triglycerides
Fibrates are drugs that reduce triglyceride levels. Triglycerides are not cholesterol, but they are fats that contribute to atherosclerosis.
There are two fibrates used in the U.S.:
Fibrates also slightly increase "good" cholesterol also called HDL.
Niacin to Improve Overall Cholesterol
Nicotinic acid, commonly called niacin, is a vitamin everyone needs in small doses. Taken in large doses, it improves cholesterol by reducing triglycerides and LDL. It also increases HDL.
Many people have uncomfortable skin flushing that prevents them from taking niacin. (Be wary of "no-flush" over-the-counter preparations: Many lack the active form of niacin.) Niacin also can increase blood sugar levels. This is a problem especially for people with diabetes.
Because of its side effects, niacin is much less frequently prescribed than statins or fibrates.
Other Drugs for Atherosclerosis
Ezetimibe (Zetia) works by reducing absorption of cholesterol in the intestines. It can lower LDL levels. But it doesn’t work as well as statins. This drug is usually used in addition to a statin to further lower bad cholesterol. There is no evidence, though, that it reduces the risk of heart attacks or strokes.
Bile acid sequestrants -- cholestyramine (Questran, Prevalite), colestipol (Colestid), colesevelam (Welchol) -- bind to bile acids in the intestines. This leads to a lower bile acid level. You need bile, so when that happens, cholesterol must be used to make more. This lowers blood cholesterol levels.