In addition to statins, what other drugs can reduce the risk of atherosclerosis?

A friend left a message asking Huazi why doctors always recommend statins for atherosclerosis. Can't other lipid-lowering drugs cure the disease? Huazi said that people have conducted a lot of experiments on the treatment of atherosclerosis, but due to the limitations of technology, statins are currently the best choice after screening, and other drugs cannot completely replace statins.

1. Risk of Atherosclerosis

Everyone knows that plaques will form after atherosclerosis. If the plaques are dissected open, you will see many small yellowish particles in them, just like millet porridge. This is also the origin of the name "atherosclerosis".

These yellowish particles are low-density lipoprotein cholesterol (LDL-C) in the blood that enters the intima and is swallowed by macrophages, eventually transforming into foam cells. Foam cells, extracellular lipids, and necrotic tissue fragments eventually form the lipid core of the plaque. Plaques will continue to cause inflammatory stimulation, and if the fibrous cap that wraps the plaque ruptures or ulcerates, it may induce thrombosis, which is the main factor causing myocardial infarction and cerebral infarction.

2. Three directions to reduce risks

Once atherosclerotic plaques are formed, it is almost impossible to completely eliminate them with existing medical technology. To prevent cardiovascular and cerebrovascular diseases induced by them, efforts can only be made in other treatment directions.

Control plaque progression : You can reduce damage to the arterial lining and slow down plaque progression by improving your diet, increasing exercise, and adopting a healthy lifestyle, as well as controlling risk factors such as high blood pressure, high blood sugar, high blood lipids, smoking, and obesity.

Perform plaque reversal : Use lipid-lowering drugs to increase plaque stability, reduce plaque volume, and reduce the incidence of rupture.

Remedy after rupture : Use antiplatelet drugs to inhibit the aggregation function of platelets. When the plaque ruptures, it can prevent platelets from aggregating and forming blood clots.

What drugs can reverse plaques?

The key to reducing the risk of atherosclerosis is to increase plaque stability and plaque reversal. This requires controlling blood lipid levels, dyslipidemia and inflammation levels, and strengthening the repair function of the arterial lining.

1. Statins : Multiple clinical trials have confirmed that statins can reduce LDL-C levels, have anti-inflammatory and antioxidant effects, and improve the metabolism of the arterial lining. Long-term use of statins to maintain LDL-C at a low level may reduce the volume of plaques and produce a reversal effect.

2. Cholesterol absorption inhibitors : Ezetimibe and Hebomibe, etc., can reduce LDL-C levels and major adverse cardiovascular events, but have little benefit in reversing plaques. The lipid-lowering intensity of such drugs used alone is not high, and they usually need to be used in combination with statins to achieve a synergistic effect.

3. PCSK9 inhibitors : Elotumab, Aliximab, etc., commonly known as "lipid-lowering injections", can significantly reduce LDL-C levels. Current clinical trials are mainly based on statins, and the effect of plaque reversal is more significant after combination therapy, but there is not enough research evidence on the effect of using the drug alone.

4. Eicosapentaenoic acid (EPA) : The main component of fish oil, it can help lower blood lipids and stabilize intima function, but its effect on the volume of atherosclerotic plaques has not yet been determined.

5. Drugs that regulate lipoprotein (a) : Lipoprotein (a) levels are related to the risk of plaques, but the relevant drugs are currently in the clinical trial stage and are not on the market.

6. Fibrates : such as fenofibrate, which mainly lowers triglyceride levels and can reduce the risk of pancreatitis. It also has the effect of lowering LDL-C levels, but there is currently a lack of research on its effects on plaques.

7. Other lipid-lowering drugs : niacin (acemidox), bile acid binding resins (cholestyramine), antioxidant drugs (probucol), etc. These drugs have more adverse reactions, are less clinically used, and have uncertain effects on plaques.

To sum up, so far, statins, or the combination of statins with PCSK9 inhibitors and cholesterol absorption inhibitors, have a significant effect in reversing plaques, while there is no clear evidence that other lipid-lowering drugs can reverse plaques and reduce the risk of atherosclerosis, so statins cannot be completely replaced.

Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.