A buildup of plaque in your arteries can potentially put your heart, brain and body at risk. But as the Cleveland Clinic points out, a class of drugs called statins targets plaque in a way that can dramatically lower your risk of heart attack and stroke.
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Plaque Causes Atherosclerosis
One of the major drivers of heart disease is atherosclerosis, which occurs when arteries narrow and clog as plaque accumulates over time, according to the U.S. National Heart, Lung, and Blood Institute (NHLBI). Plaque is primarily composed of fat, cholesterol and calcium, the institute says.
When plaque builds up, your arteries harden and narrow, interfering with the flow of blood throughout your body and putting you at greater risk for heart attack and stroke, the institute explains. Atherosclerosis is often the underlying cause of cardiovascular disease (CVD) — which is the No. 1 cause of death in the U.S., says the Cleveland Clinic.
It's not always clear what causes plaque buildup. But the NHLBI says that many factors likely play a role. Those include smoking and a poor diet, along with too much sedentary time and not enough exercise. All those behaviors are modifiable, meaning people can proactively change their habits in order to lower their risk for atherosclerosis.
In some cases, though, people simply have a family history of the disease or other factors they can't control. The good news is that there are prescription drugs to help manage the condition.
Statins Work on Plaque
"There are a number of medications that lower the risk of heart attack and stroke," says Gregg C. Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of the UCLA Preventative Cardiology Program. But the go-to, he says, is a class of medications known as statins, which he characterizes as one of the mainstays of atherosclerosis treatment.
The Cleveland Clinic notes that statins are designed to lower excessively high levels of "bad" cholesterol, which is low-density lipoprotein (LDL) cholesterol. Statins also improve the function of the lining of blood vessels and prevent blood platelets from sticking together, which helps lower the risk for blood clots, the Cleveland Clinic notes. According to Harvard Medical School, those meds include atorvastatin (Lipitor), rosuvastatin (Crestor), lovastatin (Mevacor) and pravastatin (Pravachol).
The U.S. Centers for Disease Control and Prevention (CDC) says statins work by slowing the liver's ability to produce cholesterol. Statins also boost the liver's ability to remove LDL cholesterol that's already circulating in the bloodstream.
For all of these reasons, statins are widely seen as a very effective choice for those looking to prevent CVD from developing and as a way to lower risk for those who have other risk factors for CVD (such as people with diabetes).
Should You Take Statins?
In 2018, the American College of Cardiology/American Heart Association (AHA) Task Force on Clinical Practice Guidelines issued advice on the management of blood cholesterol, including the use of statins. The guidelines, published in a June 2019 issue of Circulation, recommends that the following people take statins:
- People with atherosclerotic CVD.
- Individuals at high risk of atherosclerotic CVD.
- Those with severely elevated cholesterol levels.
- Folks 40 to 75 with diabetes and LDL levels of 70 milligrams per deciliter or higher.
- Adults 40 to 75 without diabetes, who have an LDL of 70 or higher and an estimated 7.5% or higher risk of atherosclerotic heart disease over 10 years.
- Forty- to 75-year-olds without diabetes whose estimated 10-year risk of atherosclerotic heart disease of 7.5% and 19.9%.
- Certain adults, ages 40 to 75, for whom a decision about statin therapy uncertain. Statins may be recommended depending on their coronary artery calcium score, a type of CT scan of the heart, according to NHLBI.
Dr. Fonarow says that moderate-intensity statins are generally good at stopping plaque buildup. But for some, he says, a high-intensity statin regimen may be in order. That's because high-intensity statin therapy can actually reverse plaque buildup, either when taken alone "or in combination with other lipid-lowering medications," he says.
Other Medication Options
There are other possibilities to consider. These include the cholesterol absorption inhibitor ezetimibe, as well as so-called PCSK9 inhibitors, Dr. Fonarow says.
"And in patients with high blood pressure, blood pressure lowering medications can also decrease progression of plaque and lower the risk of heart attack and stroke," he adds. He cautioned that those medications will not generally lead to a lowering of plaque buildup already in place.
- U.S. National Heart, Lung and Blood Institute: "Atherosclerosis"
- U.S. Centers for Disease Control and Prevention: "Cholesterol-lowering Medicine"
- Harvard Medical School: "Avoiding Atherosclerosis: The Killer You Can't See""
- Cleveland Clinic: "Can Statins Actually Reverse Plaque Buildup?"
- Circulation: "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines"
- NHLBI: "Coronary Calcium Scan"
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