Drugs to Treat Atherosclerosis
For millions of people at risk for atherosclerosis complications, lifestyle changes aren't enough. Fortunately, medications are available to protect against atherosclerosis -- or even partially reverse it.
Statins to Lower Bad Cholesterol
Statins are the best medications for lowering "bad" LDL cholesterol, and are the most widely used cholesterol drugs. Statins cause LDL levels to fall by up to 60%. Stains also raise levels of HDL or "good" cholesterol. And they can also help lower the level of triglycerides.
Taking a statin for a year or longer can even shrink atherosclerosis plaques slightly. This reversal of atherosclerosis surprised many experts who believed that atherosclerosis was irreversible.
Reversing atherosclerosis completely isn't yet possible. But taking a statin reduces the risk of complications from atherosclerosis considerably. For this reason, statins are often key to atherosclerosis treatment.
Fibrates to Reduce Triglycerides
Fibrates are drugs that reduce triglyceride levels. Triglycerides are non-cholesterol fats that contribute to atherosclerosis.
There are two fibrates used in the U.S.:
Fibrates also increase HDL "good" cholesterol slightly. For people with high triglycerides and a low HDL level (but whose LDL level is OK), fibrates help lower the risk for heart disease.
Niacin to Improve Overall Cholesterol
Nicotinic acid, commonly called niacin, is a vitamin we all need in small doses. When taken in large doses, it improves cholesterol by reducing triglycerides and LDL while increasing HDL.
Many people experience uncomfortable skin flushing that prevents them from continuing to take niacin. (Be wary of "no-flush" over-the-counter preparations: Many lack the active form of niacin.) Niacin also can increase blood sugar levels, a problem especially for diabetes patients.
Because of its side effects, niacin is much less frequently prescribed than statins or fibrates.
Other Drugs for Atherosclerosis
Zetia works by reducing absorption of cholesterol in the intestines. Zetia can lower LDL levels, but not as well as statins. This drug is usually used in addition to a statin to lower bad cholesterol further. There is no evidence that it reduces the risk of heart attacks or strokes.
Bile acid sequestrants (cholestyramine, colestipol, colesevelam) bind to bile acids in the intestines. This leads to a lower bile acid level; cholesterol must then be used to make more needed bile. This action lowers blood cholesterol levels.
Plant sterols are taken as supplements in pill form, or in foods like margarine. Getting plant sterols every day can reduce cholesterol modestly (about 10%).
Lovaza and Vascepa (both containing omega-3s) are prescription drugs that can be used along with diet to lower very high levels of triglycerides.
Drugs to Reduce High Blood Pressure
Lowering blood pressure reduces the risk of atherosclerosis and its complications. Diet and exercise alone don't usually bring high blood pressure down to the safe range, unfortunately. Most people with high blood pressure will require medications (usually at least two) to do the job.
There are many classes of high blood pressure drugs that work in a variety of ways. The choice of medicine isn't as important as the result: getting blood pressure down. Blood pressure should always be less than 140 over 90. For people with atherosclerosis, the goal may be below 130 over 80.