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 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.

Statins include:  

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol),
  • Lovastatin (Altoprev, Mevacor), 
  • Pitavastatin (Livalo)
  • Pravastatin (Pravachol)
  • Rosuvastatin calcium (Crestor)
  • Simvastatin (Zocor)

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 levels 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.

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Bile acid sequestrants -- cholestyramine ( Locholest, 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%.

Epanova, Lovaza, Omtryg, and Vascepa --all containing omega-3s -- are prescription drugs that can be used with diet to lower high levels of triglycerides.

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

Antiplatelets are blood thinners. They make blood less likely to clot, which can help prevent heart attacks and strokes. However, antiplatelets don't slow down or reverse atherosclerosis.

Aspirin: Plain old aspirin is actually a powerful blood thinner. A baby aspirin a day can reduce the risk of first heart attacks and strokes by about 25%.

Clopidogrel (Plavix): Clopidogrel acts similar to aspirin. This drug is useful in preventing clots from forming inside stents placed in the heart's arteries.

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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.

Prasugrel (Effient) : You take this medicine by mouth with or without food, usually once a day or as directed by your doctor. Your doctor may tell you to take it with a low dose of aspirin.

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 regimen or any other heart medication.

There are no proven cures for atherosclerosis. But medication can and lifestyle changes can reduce the risk of complications.

 

WebMD Medical Reference Reviewed by Suzanne R. Steinbaum, MD on January 07, 2018

Sources

SOURCES:

News release, FDA.
Rosenson, R. Expert Review of Cardiovascular Therapy, 2003.
Corti, R. Circulation, 2001.
Davignon, J. Circulation, 2004.
WOSCOPS group, Circulation, 1998.
Frick, M. New England Journal of Medicine, 1987.
Keech, A. Lancet, 2005.
Rosenson, R. Nature Clinical Practice: Endocrinology and Metabolism, 2007.
American Heart Association web site: "Cholesterol-Lowering Drugs," "Phytochemicals and Cardiovascular Disease," "Effects of Normal, Pre-hypertensive, and Hypertensive Blood Pressure Levels on Progression of Coronary Atherosclerosis," "Antiplatelet Agents," "Anticoagulants," "Anticoagulation," "Questions and Answers About Statin Therapy."
Antithrombotic Trialists' Collaboration, BMJ, 2002.
Mohr, J. New England Journal of Medicine, 2001.
AstraZeneca.

 

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