Medicines for Atherosclerosis

What it is

Atherosclerosis is the process in which fatty deposits (called plaques or atheroma) build up inside the walls of the arteries, causing them to narrow and harden. It is the underlying process behind most cardiovascular disease, including coronary heart disease, stroke, and peripheral arterial disease, so understanding and addressing it is central to preventing these conditions. Atherosclerosis develops gradually, often over many years, and usually begins without causing any symptoms. Over time, the plaques narrow the arteries and reduce the blood flow through them, and can also make the artery walls stiffer. Problems arise when the reduced blood flow affects an organ or tissue (for example causing angina when the heart’s arteries are narrowed, or leg pain on walking when the leg arteries are narrowed), or when a plaque ruptures and a blood clot forms on it, suddenly blocking the artery — which can cause serious events such as a heart attack or stroke. The factors that drive atherosclerosis are the familiar cardiovascular risk factors: high cholesterol, high blood pressure, smoking, diabetes, being overweight, physical inactivity, an unhealthy diet, and increasing age and family history. The important and encouraging point is that the development and progression of atherosclerosis can be slowed, and the risks it poses reduced, by addressing these risk factors — through a healthy lifestyle and, where appropriate, medicines. Because atherosclerosis is usually silent until it causes a problem, and because much of the risk is modifiable, identifying and managing cardiovascular risk factors (including through health checks) is key. The main messages are that atherosclerosis is the fatty build-up in arteries underlying most cardiovascular disease, that it develops silently over years, and that healthy living and managing risk factors slow it and reduce the risk of the serious events it can cause.

How it is treated

Atherosclerosis is managed by addressing the risk factors that drive it, through a healthy lifestyle and, where appropriate, medicines — which slow its progression and reduce the risk of the serious events (such as heart attack and stroke) it can cause. Because atherosclerosis underlies most cardiovascular disease, its management overlaps with that of cardiovascular disease generally. The cornerstone is a healthy lifestyle: not smoking (and stopping smoking, which is particularly important as smoking strongly promotes atherosclerosis); eating a healthy, balanced diet (with plenty of fruit, vegetables, and wholegrains, and less saturated fat, salt, and sugar); being physically active; keeping to a healthy weight; and drinking within recommended limits. Alongside this, managing specific risk factors is important — controlling high blood pressure, managing high cholesterol (a key driver of atherosclerosis), and managing diabetes well — through lifestyle and, where appropriate, medicines. Doctors assess a person’s overall cardiovascular risk (for example through health checks) and use this to guide advice and treatment: for those at higher risk, or with established disease, medicines such as those to lower cholesterol (statins), lower blood pressure, or reduce the risk of blood clots may be recommended, as these reduce the progression and consequences of atherosclerosis. Where atherosclerosis has caused significant narrowing and problems in a particular area (such as the heart or legs), specific treatments for that condition (including procedures in some cases) are used. Because atherosclerosis is usually silent until it causes a problem, and because addressing risk factors makes a real difference, knowing and managing your cardiovascular risk — including taking up health checks when offered — is worthwhile at any age, as the process can begin early. The reassuring and empowering message is that, although atherosclerosis underlies serious cardiovascular disease, its progression can be slowed and its risks reduced by healthy living and managing risk factors (with treatment where appropriate) — so addressing these factors protects the arteries and reduces the risk of heart attack, stroke, and other problems.