Atherosclerosis III: Management

Statins like atorvastatin inhibit cholesterol synthesis in the liver, reducing LDL cholesterol and cardiovascular risk. ACE inhibitors such as lisinopril control hypertension and prevent heart failure. Antiplatelet agents like aspirin decrease platelet aggregation, lowering thrombus formation risk. Newer agents like PCSK9 inhibitors and ezetimibe serve as add-on therapies for high-risk patients or statin-intolerant individuals.

Percutaneous transluminal angioplasty involves inserting a balloon-tipped catheter into a narrowed artery. The balloon inflates against the artery wall, compressing plaque and dilating the vessel. A stent, typically a mesh-like tube, is then deployed to support the arterial wall and maintain vessel patency, preventing re-narrowing.

Endarterectomy involves the physical excision of atherosclerotic plaque and portions of the inner arterial layers, including the intima and media. This procedure is primarily used in arteries like the carotid where significant stenosis can be life-threatening and pharmacological therapy is insufficient or rapid intervention is necessary.

Guidelines recommend at least 150 minutes weekly of moderate-intensity aerobic activity like brisk walking, or 75 minutes of vigorous activities such as jogging, supplemented by muscle-strengthening exercises twice weekly. Regular physical activity reduces body weight, lowers systolic blood pressure, and increases HDL cholesterol levels.

A heart-healthy diet reduces saturated fats while increasing whole grains, fruits, vegetables, and lean proteins. Dietary fiber lowers LDL cholesterol, while omega-3 fatty acids from fatty fish lower triglycerides and reduce cardiovascular risk. Purified EPA, in the form of icosapent ethyl, has shown significant benefits in reducing cardiovascular events in high-risk patients.

Smoking is one of the most modifiable risk factors for cardiovascular disease and significantly accelerates atherosclerosis progression. Smoking cessation is essential for controlling disease and reducing cardiovascular events. Patients should receive counseling on quitting strategies and referrals to cessation programs or pharmacotherapy as needed.

Dietary fiber and omega-3 fatty acids are key nutrients. Fiber lowers LDL cholesterol, while omega-3 fatty acids from fatty fish like salmon and mackerel reduce triglycerides. Patients should also limit sodium, simple sugars, and alcohol, particularly when triglyceride levels are elevated, to support overall cardiovascular health.