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. 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 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
Zetia (ezetimibe) 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, colestipol, colesevelam) 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.
Plant sterols are taken as supplements in pill form or in foods like margarine. Getting plant sterols every day can reduce cholesterol modestly by about 10%.
Lovaza and Vascepa (both containing omega-3s) are prescription drugs that can be used with diet to lower high levels of triglycerides.
Drugs to Reduce High Blood Pressure
Lowering blood pressure lowers the risk of atherosclerosis and its complications. Diet and exercise alone don't usually bring high blood pressure down to the safe range. 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.