What are the methods for reversing atherosclerotic plaques? What drugs can be chosen?

Atherosclerotic plaques are a concern for many friends. Many friends asked Huazi, how can we reverse the appearance of atherosclerotic plaques in the arteries, what drugs can be chosen, and which drug has the strongest effect on reversing plaques?

Hua Zi said that cardiovascular events related to atherosclerotic plaques are one of the leading causes of death worldwide. In recent decades, many drugs for treating atherosclerotic plaques have been developed, and with the development of imaging, the effects of these drugs on plaques can be evaluated in more detail.

1. Formation of plaque

The formation of atherosclerotic plaques is due to the long-term effects of pathogenic factors such as smoking, hypertension, hyperlipidemia, and diabetes , which lead to arterial endothelial dysfunction and increased endothelial cell permeability, allowing low-density lipoprotein cholesterol (LDL-C) in the blood to enter the intima.

Macrophages in the intima will phagocytize LDL-C in large quantities, eventually forming foam cells that are deposited in the endothelium . Vascular smooth muscle cells proliferate around the foam cells, forming a fibrous cap that covers their surface, ultimately leading to the formation of atherosclerotic plaques.

Pathogenic factors such as smoking, blood pressure, blood lipids, and blood sugar are controllable . As long as they are controlled in time, they can have the effect of "cutting off the fuel from under the cauldron" for atherosclerotic plaques.

2. Reduction of plaques

Because foam cells cannot be removed once formed, for a long time people thought that atherosclerotic plaques were irreversible. But later it was found that the diameter of the arteries of some people increased, which meant that the plaques had regressed.

Modern imaging technology has confirmed that the size of the regressed plaques not only decreases, but their internal composition also changes, with less lipids, higher density, and a lower risk of rupture .

However, not all plaques are reversible. For example, hard plaques and calcified plaques cannot be reversed. However, the probability of rupture of such plaques themselves is also very small. They are considered to be stable plaques and are not very dangerous.

3. Methods to reverse plaque

Non-drug methods :

Adjusting diet and exercising are effective intervention measures for atherosclerotic plaques, but simply adjusting diet has limited effects because 70% of LDL-C, which is closely related to atherosclerotic plaques, is produced by the human body itself, while the food we eat can only account for 30%.

Exercise is an effective intervention measure for atherosclerotic plaques . In relevant studies, patients who exercise more have more obvious plaque regression. In addition, studies have shown that athletes are mostly stable hard plaques, while sedentary people are mostly unstable soft plaques. Therefore, exercise is an effective non-drug method to reverse plaques .

Drug method :

1. Statins : Statins are mainly used for lipid-lowering therapy, which can reduce LDL-C levels by about 30% to 50%. The degree of cardiovascular risk is related to the degree of reduction in LDL-C levels, so LDL-C levels are a common indicator used to detect treatment effects.

In the study, it was found that statins can reduce the total volume of plaques by up to 20% , while the plaque volume of people who do not use statins does not shrink, but increases. Statins can also increase the fiber in the plaque, reduce lipids and necrosis, and increase the stability of the plaque.

2. Cholesterol absorption inhibitors : Ezetimibe can inhibit intestinal absorption of cholesterol and further reduce LDL-C levels. However, studies have found that ezetimibe can reduce cardiovascular risk but has little effect on plaque volume.

3. PCSK9 inhibitors : Related studies have shown that the combined use of PCSK9 inhibitors (evolocumab, alirocumab) on the basis of statins can further reduce the risk of adverse cardiovascular events, and compared with the use of statins alone, the combined use of PCSK9 inhibitors can result in a more significant reduction in plaque volume .

4. Other lipid-lowering drugs : In related studies, cholesterol ester transfer protein inhibitors, eicosapentaenoic acid (ω-3 fatty acids), niacin, fibrates and other drugs were studied, and no effect on plaque regression was found.

5. Oral hypoglycemic drugs : In diabetic patients, the use of insulin sensitizer thiazolidinediones (pioglitazone, rosiglitazone) can lead to greater plaque regression.

To sum up, atherosclerotic plaques cannot be completely eliminated after they are formed, but they can be partially reversed. Increasing exercise and adhering to statin treatment are currently the most effective ways to reverse plaques . Although other drugs can reduce cardiovascular risks, they cannot replace the role of statins in reversing plaques. The use of drugs needs to be carried out under the guidance of a doctor. If you have any questions about the use of drugs, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.