What're the treatments for atherosclerosis?
If atherosclerosis leads to symptoms, the symptoms (such as angina pectoris) can be treated. Medicines are usually the first step in treating cardiovascular diseases, and with improvements, have increasingly become the most effective method over the long term. However, medicines are critised for their expense, patented control and occasional undesired effects.
Lipoprotein imbalances, upper normal and especially elevated blood sugar, i.e. diabetes, high blood pressure, homocysteine, stopping smoking, taking anticoagulants (anti-clotting agents) which target platelets, taking Omega 3 oils from salt-water fish meats, exercising and losing weight are the usual focus of treatments which have proved to be helpful in clinical trials.
Dramatic lowering of lipoprotein levels, including to very abnormally low levels for adults (and especially the smaller lipoprotein particles), and elevating the large particle (HDL) can slow, stop, or even partially reverse the buildup of plaque, as demonstrated in clinical trials. LDL lowering can reduce the macrophage and lipid content and size of unstable plaques, making them more stable and less prone to rupture. Lowering lipoprotein little a, a genetic variant of the LDLipoproteins, can be achieved with large daily doses of vitamin B3, niacin. Niacin also tends to shift LDLipoprotein particle distribution to larger particle size and improve HDLipoprotein functioning. Work on increasing HDL particle concentration and function, beyond the niacin effect, perhaps even more important, is slowly advancing. Combinations of statins, niacin, intestinal cholesterol absorption inhibiting supplements (ezetimibe and others, and fibrates have been the most successful in changing dyslipidemia patterns with better clinical outcomes. Dietary changes to achieve this have been more controversial, generally far less effective and less widely adhered to with success.
Evidence has increased that people with diabetes, though without clinically detectable atherosclotic disease, have more severe debility from atherosclerotic events over time than even non-diabetics who have already suffered atherosclerotic events. Thus diabetes has been upgraded to be viewed as an advanced atherosclerotic disease equivalent.
Lowering homocysteine levels, including within the normal range and dietary supplements of Omega 3 oils, especially those from the muscle of some deep salt water living fish species, also have clinical evidence of significant protective effects.
Aerobic exercise, weight loss, and dietary changes can also help in major ways, but are often more problematic for many to achieve and continue long term.
Medical treatments often focus predominantly on the symptoms. Over time, the treatments which focus on decreasing the underlying atherosclerosis processes, as opposed to treating the symptoms resulting from the atherosclerosis, have been shown by clinical trials to be more effective.
Other physical treatments, helpful in the short term, include minimally invasive angioplasty procedures to physically expand narrowed arteries and major invasive surgery, such as bypass surgery, to create a blood supply connection which goes around the more severely narrowed areas.
Unfortunately, high dose supplements of vitamin E and/or C, with the goal of improving antioxidant protection, have failed to produce any beneficial trends in human, double blind, clinical research trials. On the other hand, the statins, and some other medications have been shown to have significant antioxidant effects, perhaps part of their basis for theraputic success.
In summary, they key to the more effective approaches has been better understanding of the insidious nature of the disease and to combine multiple different treatment strategies, not rely on just one or a few approaches. Additionally, for those approaches, such as lipoprotein transport behaviors, which have been shown to produce the most success, being more treatment aggressive has generally produced better results, both before and especially after people are symptomatic. However treating asymptomatic people remains controversial.
Patients at risk for atherosclerosis-related diseases are increasingly being treated prophylactically with low-dose aspirin and a statin. The high incidence of cardiovascular disease led Wald and Law (2003) to propose a Polypill, a once-daily pill containing these two types of drugs in addition to an ACE inhibitor, diuretic and beta blocker and folic acid. They maintain that high uptake by the general population by such a Polypill would reduce cardiovascular mortality by 80%.