Do statins remove plaque

Reversing Atherosclerosis

Dr. Howard Weintraub, a cardiologist at NYU Langone Medical Center, says that once you’re diagnosed with atherosclerosis, the most you can do is make the disease less dangerous.

He also explains that “in the studies that have been done so far, the amount of reduction in plaque buildup that’s seen over the course of a year or two is measured in a 100th of a millimeter.”

Medical treatment combined with lifestyle and dietary changes can be used to keep atherosclerosis from getting worse, but they aren’t able to reverse the disease.

Some medications may also be prescribed to increase your comfort, particularly if you’re having chest or leg pain as a symptom.

Statins are the most effective and commonly used cholesterol-lowering drugs in the United States. They work by blocking the substance in your liver that the body uses to make low-density lipoprotein (LDL), or bad cholesterol.

According to Dr. Weintraub, the lower you knock the LDL down, the more likely it is that you’ll get the plaque to stop growing.

There are seven commonly prescribed statins available in the United States:

Healthy dietary changes and regular exercise are both very important parts of reducing high blood pressure and high cholesterol, two major contributors to atherosclerosis.

Even if your healthcare provider prescribes a statin, you’ll still need to eat healthy foods and be physically active.

Dr. Weintraub says, “anybody can out-eat a medicine that we give them.” He cautions that without the proper diet “the medicine still works, but not as well.”

If you smoke, quit smoking. Smoking causes a buildup of plaque in the arteries. It also reduces the amount of good cholesterol (high-density lipoprotein, or HDL) you have and can raise your blood pressure, which can increase stress on your arteries.

Here are some other lifestyle changes you can make.

Exercise

Aim for 30 to 60 minutes per day of moderate cardio.

This amount of activity helps you:

  • lose weight and maintain your healthy weight
  • maintain a normal blood pressure
  • boost your HDL (good cholesterol) levels

Dietary changes

Losing weight or maintaining your healthy weight can lower your risk for complications due to atherosclerosis.

The following tips are a few ways to do this:

  • Decrease sugar intake. Reduce or eliminate consumption of sodas, sweet tea, and other drinks or desserts sweetened with sugar or corn syrup.
  • Eat more fiber. Increase consumption of whole grains and have 5 servings a day of fruit and vegetables.
  • Eat healthy fats. Olive oil, avocado, and nuts are healthy options.
  • Eat leaner cuts of meat. Grass-fed beef and chicken or turkey breast are good examples.
  • Avoid trans fats and limit saturated fats. These are mostly found in processed foods, and both cause your body to produce more cholesterol.
  • Limit your sodium intake. Too much sodium in your diet can contribute to high blood pressure.
  • Limit your alcohol intake. Drinking regularly can raise your blood pressure, contribute to weight gain and interfere with restful sleep. Alcohol is high in calories, just one or two drinks a day can add to your “bottom” line.

What if medication and dietary changes don’t work?

Surgery is considered aggressive treatment and is only done if the blockage is life-threatening and a person hasn’t responded to medication therapy. A surgeon may either remove plaque from an artery or redirect blood flow around the blocked artery.

How Statin Drugs Protect the Heart

“Traditionally, statins were viewed as purely cholesterol-lowering drugs. So it made sense just to use them for people with high cholesterol,” explains Johns Hopkins cardiologist Michael Blaha, M.D.“But we’ve learned that they also benefit people with lower levels of cholesterol who are at a high risk of heart disease. So we now think of statins as risk-reducing drugs.”

This dramatic change in thinking means that people who once were not candidates for statins are now prescribed them to lower their risk of heart attack and stroke.

How statins work

Statins help lower low-density lipoprotein (LDL) cholesterol, also known as “bad” cholesterol, in the blood. They draw cholesterol out of plaque and stabilize plaque, Blaha says. Plaque is a waxy substance consisting mainly of cholesterol deposits that can build up within the walls of the arteries, interfering with blood flow to and from the heart and leading to heart attack and stroke.

Early on, plaque build-up can be controlled by healthy lifestyle choices, such as switching to a heart-healthy diet, exercising and not smoking. If those efforts are unsuccessful over time, doctors will introduce treatment with statins to benefit the arteries and prevent further damage.

Who gets statins?

Being prescribed statins is no longer simply a result of having poor cholesterol numbers. Instead, doctors use a variety of ways to identify high-risk patients. These include examining all of your heart-health measures (including blood pressure, blood glucose and body-mass index) as well as the results of tests that assess plaque build-up, such as a coronary calcium scan.

Statin risks and benefits

Are statins safe? For most people, the answer is a resounding yes, according to a 2014 Johns Hopkins meta-analysis of 20 years worth of published research. It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. Researchers combed through hundreds of papers that had studied statins since 1994 to determine the evidence of side effects.

Their review, published in British Medical Journal, found an increase in the risk of muscle aches. There was also a modest risk of elevated blood glucose, which can tip some people into developing type 2 diabetes. What’s unclear is whether those people, who also had other risk factors for diabetes, would have developed the condition anyway. Statins don’t cause memory loss or cataracts, as has been claimed in the past. For most at-risk patients, the benefits far exceed the risks, the researchers concluded. Of course, if you notice any unusual effects after beginning statin therapy, tell your doctor.

“We know a lot about statins because they’ve been around for a long time and taken by so many people,” Blaha says. “The scale clearly tips to benefits in most at-risk patients.”

For the first time, a new drug given along with a cholesterol-lowering statin medicine has proved able to shrink plaque that is clogging arteries, potentially giving a way to undo some of the damage of heart disease.

The difference was very small but doctors hope it will grow with longer treatment, and any reversal or stabilization of disease would be a win for patients and a long-sought goal.

A bodega worker gives a blood sample for a cholesterol check during a free health-screening clinic for New York bodega convenience store workers on July 20, 2010 in the Bronx borough of New York.Chris Hondros / Getty Images file

The drug, Amgen Inc.’s Repatha, also drove LDL, or bad cholesterol, down to levels rarely if ever seen in people before. Heart patients are told to aim for below 70, but some study participants got as low as 15.

“There doesn’t appear to be any level at which there is harm” from too little LDL, and the lower patients went, the more their plaque shrank, said one study leader, the Cleveland Clinic’s Dr. Steven Nissen.

Results were published Tuesday by the Journal of the American Medical Association and discussed at an American Heart Association conference.

“It’s small, but it probably took patients 60 years to accumulate that plaque.”

Statins such as Lipitor and Crestor curb cholesterol production. Repatha and a similar drug, Praluent, block PCSK9, a substance that interferes with the liver’s ability to remove cholesterol from the blood. Too much cholesterol, along with other substances, can build up and form plaque in arteries.

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The new drugs have drawbacks, though. Statins are pills sold as generics for as little as a dime a day. The new ones are biotech drugs that are expensive to make – Repatha costs $14,000 a year and insurers often won’t pay. They must be given as shots every two weeks or once a month. People can do it themselves with a penlike device.

Related: FDA Approves Pricey New Cholesterol Drug

In the study, about 900 heart disease patients were given a strong statin and monthly shots of either Repatha or a dummy solution. Ultrasound images were taken of an artery with plaque at the start of the trial and 18 months later.

The average for bad cholesterol stayed around 93 for people given only the statin, but dropped to 37 for those on both drugs. The amount of artery plaque stayed about the same for the statin-only group but shrank 1 percent in those also given Repatha. Some people with more dramatic LDL declines saw plaque shrink 2 percent.

“It’s small, but it probably took patients 60 years to accumulate that plaque,” so to see any change after just 18 months of treatment is good, said a cholesterol expert, Dr. Raul Santos of the University of Sao Paolo.

Dr. Vincent Bufalino, president of Advocate Medical Group, a large cardiology group in suburban Chicago, agreed.

“It sounds small but it’s a beginning” and still a win, he said.

Amgen sponsored the study, and Santos has consulted for the company. Nissen said his fees for doing the study were donated to charity.

Related: Who Needs Statins and Who Needs More?

The best test of the new drugs’ value will be large studies underway now to see whether drops in cholesterol will lead to fewer heart attacks and deaths. Results are expected next year.

Also at the conference, doctors gave results of a safety study of an experimental treatment aimed at rapidly removing cholesterol after a heart attack to help prevent a second one.

“When you have a heart attack, your ability to get cholesterol out of plaque is actually worsened. Your plaques grow more plump….the pipes are getting even more clogged,” said Dr. C. Michael Gibson, professor of medicine at Harvard University.

He led a study in 1,250 people testing infusions of ApoA-1, the main component of HDL, or good cholesterol, which helps remove the bad kind. The substance is taken directly from human blood, not synthesized in a lab.

An earlier version showed side effects on the liver; this one was modified to try to avoid that, and no safety roadblocks were seen, said Gibson, who consults for the treatment’s maker, CSL Behring.

Q: Can statins actually reverse plaque buildup?

A: Yes. There have been several clinical studies — many of them done here at Cleveland Clinic — that show statins can reverse plaque buildup.

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Two statins in particular, atorvastatin, which is sold under the brand name Lipitor®, and rosuvastatin, which is sold under the brand name Crestor®, are the strongest statins.

Clinical studies using ultrasound in the coronary arteries have shown that when you are on high doses of these medicines, even if you have plaque buildup already, you can stabilize the plaque on statin therapy.

If your LDL cholesterol is lowered below 70 mg/dL, you can even see regression in the plaque by up to 24 percent. So having really a low LDL cholesterol level can help stabilize any plaque buildup you have, and prevent further plaque progression.

— Preventive cardiologist Haitham Ahmed, MD, MPH

PMC

New insights on the effects of statins on atherosclerotic plaques

A new meta-analysis by Banach et al. reinvestigated the effect of statins on atherosclerosis progression and was recently published in BMC Medicine. The authors included nine studies with more than 830 individuals in whom virtual histology data was available. This study supported previous findings that higher statin doses result in significant plaque volume reduction, while lower statin doses does not. More interestingly, the pooled virtual histology data demonstrated that this small change in plaque volume is a poor summary of plaque composition change. On the one hand, the fibro-fatty and necrotic core volumes remained unchanged with statin use; and on the other hand, a significant fibrous plaque volume reduction accompanied a significant increase in the dense calcium volume. The data also suggests that there is a direct correlation between statin intensity used in each study and the effects on fibrous plaques and on dense calcium volumes, despite the limited power of subgroup analysis. Another very recent meta-analysis reached similar conclusions using different analytical techniques .

An interesting aspect of plaque composition derived from the study by Banach et al. is the role of coronary calcification in the atherosclerotic process and its implications on cardiovascular risk assessment. While some authors propose that calcium formation is part of the healing and stabilizing process of atherosclerosis, other in vitro studies indicate that calcium location may better explain the difference in plaque rupture risk . In fact, while clinical studies have firmly documented a direct association between the overall calcification in coronary arteries (measured as either the Agatston score or calcium volume) and cardiovascular events, other studies suggest that the pattern and distribution of calcium in coronary plaques may equally matter. A classical coronary computed tomography (CT) angiography study by Motoyama et al. indicated that small “spotty” calcifications are associated with future plaque ruptures, whereas a sub-analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study demonstrated that calcium density is inversely associated with events risk. These results, grounded by cellular and molecular data on the mechanisms regulating the pattern of atherosclerotic calcification, suggest that smaller calcium deposition (pro-inflammatory-driven microcalcifications) are associated with plaque rupture and increased cardiovascular risk, while larger, denser calcium structures (anti-inflammatory-driven macrocalcifications) are associated with plaque stabilization and better outcomes, in agreement with the increased dense calcification documented with statin treatment .

Collectively, these results indicate that instead of regression, the use of statins can lead to plaque healing and stabilization. The “healed” plaque is only discretely smaller, although it has better structure and is less prone to rupture. Even so, the occurrence of cardiovascular events despite optimized treatment in a significant proportion of patients receiving statins, the so-called “residual risk”, suggests that the healing process is incomplete. In fact, it has been proposed that statins and other preventive measures alter the mechanisms leading to acute coronary syndromes. Instead of plaque rupture, acute coronary syndromes in those “healed” plaques are more likely to occur by erosion. This change is thought to be related to the improved plaque structure associated with the change in its components.

Is it possible to unclog your arteries?

Eating a heart-healthful diet and regularly exercising can be powerful tools for preventing clogged arteries. These disciplines also make a person feel better as time goes on.

People can prevent clogged arteries with the following lifestyle changes:

Avoiding trans fats

The type of fat a person eats can affect plaque in the arteries. The American Heart Association (AHA) recommend that a person limits their intake of saturated fats and trans fats. This is because these kinds of fats contain high levels of LDL cholesterol, which is the main material of plaque in the arteries.

Foods that are high in trans fats include:

  • fried foods
  • processed packaged foods
  • cakes, pies, and pastries
  • cookies and biscuits
  • margarine or butter substitutes
  • vegetable shortening
  • products with partially hydrogenated oils, otherwise known as trans fats

Along with trans fats, saturated fats may also affect heart health, though the evidence for this is mixed. Saturated fats are mostly found in animal products, such as beef, pork, and dairy, but also in coconut oil and palm oil.

One review of scientific studies found there was a small but possibly important reduction in the risk of cardiovascular issues when people cut down on saturated fats and replaced them with unsaturated fats.

Another review study suggests that people should avoid saturated fats because they increase LDL cholesterol in the body, which is a direct cause of heart issues.

Eating more unsaturated fats

Share on PinterestAvocados, walnuts, and fatty fish all contain unsaturated fats.

Unsaturated fats are the good fats. They contain HDL cholesterol, which can help to take bad cholesterol from the arteries before it turns into plaque.

According to the AHA, unsaturated fats may help improve blood cholesterol when eaten instead of trans or saturated fats.

Unsaturated fats are mainly found in plants and fatty fish. Sources include:

  • avocado
  • olives
  • walnuts
  • some vegetable oils including sunflower and olive
  • fatty fish, including trout, herring, and salmon

Following other dietary tips

The AHA recommend that people aiming to lower their LDL cholesterol eat a diet rich in:

  • whole fruits and vegetables
  • nuts
  • whole grains
  • low-fat dairy
  • fish
  • poultry

They also recommend limiting sugary foods, red meat, and sugar-sweetened beverages.

Drinking herbal teas

Drinking teas, such as green or black tea, rooibos tea, or ginger tea may be good heart-healthy substitutes for other beverages.

A study from 2011 found that drinking 6 cups of rooibos tea per day for 6 weeks helped to lower the amount of LDL cholesterol in the blood in adults who were at risk for heart diseases.

Green tea can also help. A 2011 review reported that green tea and its extracts could lower LDL cholesterol in the blood, though this did not affect HDL cholesterol.

Ginger supplementation may also improve significant markers that can lead to cardiovascular events, according to a 2016 study. Ginger root can be found as a supplement, but people can also brew it in hot water, and drink it as a tea.

A range of herbal teas is available for purchase online.

Exercising regularly

Obesity is a risk factor for plaque buildup and heart disease. In addition to eating a healthful diet, regularly exercising may help a person to lose weight and reduce their risk of heart problems.

Taking part in cardiovascular exercise, otherwise known as cardio, on a regular basis may also help strengthen the heart and reduce plaque.

Simple cardio activities that raise the heart rate include:

  • jogging
  • cycling
  • running
  • brisk walking
  • swimming
  • playing tennis
  • doing aerobics

A person should aim to do 30 to 60 minutes of exercise that raises the heart rate for a good workout. A doctor may recommend a specific exercise routine to fit an individual, based on various lifestyle factor.

Other ways to prevent clogged arteries

Stop smoking. According to the AHA, smoking is a major risk factor. It directly damages the arteries and can make fatty deposits grow faster and become larger.

Stress reduction. Psychological stress levels may also cause a reaction in the body. Stress-reduction techniques, including yoga, meditation, or breathing exercises may help some people relax during a hectic day.

Medical treatments

When prevention methods are not effective, a person may need medical intervention to try and alleviate the effects of clogged arteries.

A doctor may recommend medications to lower LDL cholesterol to use alongside dietary changes. These actions should be seen as an additional help rather than as solutions.

Similarly, a blocked artery may require surgical treatment. This could involve inserting a tube into the artery to remove the plaque while leaving behind a stent to support the artery walls and increase blood flow.

With severe blockages, doctors may perform surgery called a heart bypass to make sure the blood can get around the obstructed artery.

Below is a 3-D model of atherosclerosis, which is fully interactive. You can explore this model using your mouse pad or touchscreen.

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