Atherosclerosis

Definition:

Atherosclerosis is a chronic disease whereby certain risk factors increase the propensity for cholesterol accumulation and/or scar tissue formation within the walls of the artery.  Atherosclerosis may involve virtually any blood vessels in the body including coronary arteries, carotid arteries, cerebral arteries, aorta, mesenteric (GI tract) arteries, kidney arteries, and those involving the lower extremities.

Prevention:

  • Avoid smoking
  • Maintain/control high blood pressure
  • Maintain/control high cholesterol
  • Maintain an active lifestyle
  • Maintain an ideal body weight
  • Maintain/control diabetes
  • Maintain a healthy diet

Treatment:

  • Cholesterol-Lowering Drugs
    • Statins — These are usually the drugs of choice as they are easy to take and have few interactions with other drugs. Statins include:
      • Lovastatin (Mevachor)
      • Pravastatin (Pravachol)
      • Rosuvastatin (Crestor)
      • Simvastatin (Zocor)
      • Atorvastatin (Lipitor)
      • Fluvastatin (Lescor)
    • Niacin (nicotinic acid) — In prescription form, niacin is sometimes used to lower LDL cholesterol. It can be more effective in raising HDL cholesterol than other medications.
    • Cholesterol absorption inhibitors — The medication ezetimibe (Zetia) limits how much LDL cholesterol can be absorbed in the small intestine.
    • Fibric acid derivatives — These medicines are effective at lowering triglyceride levels, and moderately effective at lowering LDL. They are used to treat high triglycerides and low HDL in people who cannot take niacin. Side effects include myositis, stomach upset, sun sensitivity, gallstones, irregular heartbeat, and liver damage.
      • Gemfibrozil (Lopid)
      • Fenofibrate (Tricor, Lofibra)
    • Beta blockers — slow down the heart rate (reducing the workload on the heart) and reduce stress hormones in the body (which allows blood vessels to relax). Beta blockers include:
      • Atenolol (Tenormin)
      • Bisoprolol (Zebeta)
      • Metoprolol (Lopressor, Toprol XL)
      • Nadolol (Corgard)
      • Timolol (Blocadren)
      • Nebivolol (Bystolic)
    • Angiotensin-converting enzyme (ACE) inhibitors — block the chemical angiotensin from forming in the body, helping prevent blood vessels from narrowing. ACE inhibitors include:
      • Captopril (Capoten)
      • Benazepril (Lotensin)
      • Enalapril (Vasotec)
      • Lisinopril (Prinivil, Zestril)
      • Fosinopril (Monopril)
      • Ramipril (Altace)
      • Perindopril (Aceon)
      • Quinapril (Accupril)
      • Moexipril (Univasc)
      • Trandolapril (Mavik)
    • Blood-thinning drugs — antiplatelet agents and anticoagulants are used to keep blood clots from forming.
    • Several different procedures (surgical and non-surgical) may be performed depending upon which arteries are narrowed and how much they are blocked.
      • Angioplasty — used to widen narrowed arteries. A surgeon inserts a catheter with a deflated balloon into the narrowed part of the artery. The balloon is inflated, widening the blood vessel so blood can flow more easily. The balloon is then deflated, and the catheter is removed. A permanent stent (wire mesh) may be put in to hold the artery open and improve blood flow.
      • Atherectomy — a procedure to remove plaque from the arteries. It uses a laser catheter or a rotating shaver.
      • Bypass surgery — A surgeon uses a blood vessel from another part of your body or an artificial tube to reroute blood around clogged arteries.
      • Minimally invasive bypass surgery — uses a small incision rather than the broad opening in the chest wall created during regular bypass surgery.
      • Endarterectomy — used to remove plaque in the carotid (neck) or peripheral arteries.