Can carotid artery plaques really be reversed? To reverse plaques, certain conditions must be met

A friend asked Huazi that she had been taking statins for 2 years, but her carotid artery plaques did not shrink. She read some articles saying that arterial plaques cannot be reversed, and some articles said that taking statins can reverse plaques. Which statement is correct? Can plaques really be reversed?

Huazi told her that the different conclusions of the articles she read were because they looked at arterial plaques from two different perspectives. In fact, statins can achieve "partial reversal" of plaques in the arteries, but certain conditions must be met.

1. Can arterial plaques be reversed? When the arterial intima is damaged, low-density lipoprotein cholesterol (LDL-C) in the blood will enter the intima from the damaged area. The macrophages in the human body will engulf the LDL-C that enters the arterial intima. Macrophages that engulf too much LDL-C will transform into foam cells and deposit in the arterial intima, becoming the lipid core of the plaque.

The vascular smooth muscle cells around the lipid core secrete extracellular matrix to wrap the lipid core and form a fibrous cap to cover it. With the current medical level of human beings, there is no way to remove foam cells from the arterial lining without destroying the arterial intima, so traditional theory believes that once arterial plaques are formed, they cannot be reversed.

However, after the advent of statins, there is hope for the reversal of arterial plaques. Statins can significantly reduce the level of LDL-C. Related studies have found that when the LDL-C level in the blood is reduced to 2.0mmol/L, LDL-C stops transferring into the arterial intima. When the LDL-C level in the blood is reduced to 1.8mmol/L, the free LDL-C in the arterial intima will transfer back to the blood.

Subsequent studies have found that in addition to lowering LDL-C levels, statins can also improve the metabolism of the arterial lining, counteract the oxidation and inflammatory reactions produced by LDL-C, and increase the density of the lipid core of the plaque and reduce its volume. Although it cannot completely eradicate the plaque, it can achieve the effect of reversing the plaque by reducing its volume.

2. Conditions for statins to reverse plaques Statins can “reverse” plaques by reducing their volume, but they cannot completely reverse and eliminate them. However, to reduce the volume of plaques, certain conditions are required.

1. Sufficiently low LDL-C level: In relevant tests, the reversal of plaques can only be observed when LDL-C is at least reduced to below 1.8mmol/L. And for some people, the reversal effect can only be achieved when the LDL-C is below 1.4mmol/L. So now there is a saying, "If your plaques are not reversed, it means that your LDL-C is not low enough."

2. Sufficiently long medication time: In clinical trials of statins, 2 to 4 years of continuous medication are required to observe plaque volume reduction, and most of them occur in people who take the medication for more than 4 years. The longer the medication is taken, the more obvious the effect.

3. Related to the nature of the plaque itself: The essence of statins in reversing plaques is to increase plaque density, reduce plaque volume, and make plaques "harder." However, some people's plaques are hard plaques with high density and no room for shrinkage, so they can only play a role in delaying the progression of plaques. Only for soft plaques with large lipid cores and low density can a significant reversal effect occur.

4. Correct interpretation of plaque data: When doing a carotid ultrasound examination, the two values ​​multiplied together are the length and width of the plaque, which represent the area of ​​the plaque, and the thickness of the carotid intima represents the volume of the plaque. With aging, the plaque area may continue to increase, but flat plaques have little effect on the body, and thickened plaques will cause arterial stenosis. Reversal of statins will thin the thickness of the arterial intima, but usually will not reduce the plaque area.

3. Don’t be too concerned about the reversal of plaques. The most important purpose of using statins is to stabilize plaques. Because the biggest danger of atherosclerotic plaques is the rupture of the unstable plaque fiber cap. The ruptured plaque surface will activate platelet aggregation, form thrombi, and eventually block blood vessels, which is the most important factor causing cerebral infarction and myocardial infarction.

As long as the plaque does not cause severe stenosis of the blood vessels, it will hardly affect daily life, as long as it is controlled so as not to rupture. Statins can increase the stability of plaques, turning unstable plaques into stable plaques, reducing the probability of rupture, and thus avoiding the occurrence of acute cardiovascular and cerebrovascular events.

To summarize, statins can partially reverse plaques, but they require that LDL-C be controlled at a low level, that the medication be taken for a long period of time, and that the texture of the plaques is relatively "soft" in order to achieve a more obvious reversal effect.

Everyone should understand one thing. The main goal of using statins is to delay the progression of plaques, increase plaque stability, and prevent plaque rupture. This will protect your health well, and there is no need to force a reversal effect. The drug must be used under the guidance of a doctor. If you have any questions about the use of the drug, please consult a doctor or pharmacist in time. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.