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 for most people. 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. It decreases inflammation, which stabilizes the plaque. For this reason, statins are often key to treating atherosclerosis.
Fibrates to Reduce Triglycerides
There are two fibrates used in the U.S.:
Fibrates also slightly increase "good" cholesterol also called HDL.
Niacin to Improve Overall Cholesterol
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 Lower Cholesterol
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 (Prevalite, Questran), 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.
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%.
Alirocumab (Praluent) and evolocumab (Repatha) are included in a new class of drugs called proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors. They are for use by patients who cannot control their cholesterol through diet and statin treatments. For those with established cardiovascular disease, evolocumab has also proven to be effective in significantly reducing the risk of heart attacks and strokes.
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. Guidelines released in 2017 states that normal blood pressure should be less than 120/80. Blood pressure goals for people being treated for high blood pressure vary according to their other health problems.
Drugs to Reduce the Risk of Blood Clots
Ticagrelor (Brilinta): Ticagrelor is similar to clopidogrel. This drug is less effective if patients take more than 100 milligrams a day of aspirin. A "baby aspirin" contains 81 milligrams of aspirin. An FDA "black box" warning tells doctors about the risk of using higher doses of aspirin along with ticagrelor.
Warfarin (Coumadin): This powerful blood thinner is an anticoagulant. It is not generally used to treat atherosclerosis. Warfarin is used for other medical conditions that involve blood clots, for example, atrial fibrillation and deep vein thrombosis. It has not been shown to be better than aspirin in preventing heart attacks.
The benefits of blood thinners come at the price of an increased risk of bleeding. For most people at risk from atherosclerosis, though, the benefits of antiplatelets outweigh the risks. Speak with your doctor before starting an aspirin or any other heart medication.
A daily dose of colchicine (0.5 mg or 0.6 mg) has proven effective in helping preventing atherosclerosis in some patients. Inflammation plays a pivotal role in coronary disease and this medication, normally used for treating gout, has shown some success because of its antiinflammatory proerties.
There are no proven cures for atherosclerosis. But medication can and lifestyle changes can reduce the risk of complications.