April 11, 2022 Author : Victor Gil It is currently possible to identify atherosclerosis when there are no symptoms and to intervene early to prevent or delay the disease progression. In cases of established atherosclerosis, the wide range of therapeutic options makes it possible to design a plan adapted to each person and their disease. The earlier therapeutic measures are initiated, the more effectively complications are avoided. Treatment of atherosclerosis Healthy lifestyle habits, including healthy eating and physical exercise, are preventive measures, but they are also the first step in treating atherosclerosis . In some cases, these habits may even be the only need to solve the problem and play a fundamental role in controlling all cardiovascular risk factors; In other circumstances, medication or invasive procedures may also be necessary. Drug therapy When necessary, pharmacological or drug therapy often includes statins and other medicines for cholesterol, antihypertensives, antidiabetics, and antiplatelet coumpounds. Statins and other medicines for cholesterol Statins are often prescribed to lower cholesterol, improve artery health, and prevent atherosclerosis. Statins are extremely safe drugs with very rare side effects and are very effective in preventing the progression of atherosclerosis and acute cardiovascular events occurrence. There are many other types of medicines that lower cholesterol, for example a cholesterol absorption inhibitor called ezetimibe. Aggressively lowering blood levels of low-density cholesterol (LDL) — the bad cholesterol — can slow, or even stop, the buildup of fatty deposits in the arteries. Antihypertensives Proper treatment of arterial hypertension also contributes to delaying the progression of atherosclerosis. Some drugs used in the treatment of hypertension appear to have a direct effect . Anti-diabetics Some drugs used in the treatment of diabetes – both the more classic, such as metformin – and the more recent – called i-SGLT2 and a-GTP1 – seem to have stabilizing effects on atherosclerotic plaques . Proper treatment of diabetes is essential to reduce the cardiovascular risk associated with it due to the direct effect that high sugar levels have on the arteries. Platelet antiaggregants Aspirin and other antiplatelet drugs play an important role after a heart attack or a stroke . Its use in stable patients with atherosclerotic plaques is controversial and requires an individualized decision. Invasive treatment of atherosclerosis In certain cases, more aggressive procedures are needed to treat atherosclerosis. For example, when there are severe symptoms or a blockage to blood flow , coronary angioplasty, endarterectomy, or coronary artery bypass surgery may be recommended. Coronary angioplasty This procedure, also known as percutaneous coronary intervention, helps to open a blocked artery . It is done by interventional cardiologists. The affected artery is opened using a catheter that has a balloon and the balloon is inflated into place. Sometimes this opening with the balloon is enough, in other cases a metallic mesh (or stent) is placed to keep the artery permeable. Endarterectomy Endarterectomy is the surgical removal of atherosclerotic plaque from the walls of a stenosed (narrowed) artery . It is mainly used in the carotid arteries and is performed by vascular surgeons. Coronary artery bypass surgery In coronary bypass surgery, a 'diversion' is created for the blood to bypass an area of the coronary arteries that is obstructed , thus allowing the blood to reach the territory of the heart following the obstruction. Fragments of other arteries, such as the internal mammary artery, the radial artery, or the saphenous vein, can be used to create the bypass. Coronary bypass is performed by heart surgeons. Prevention and lifestyle The same healthy lifestyle habits recommended to treat atherosclerosis also help prevent it and control other cardiovascular risk factors. Lifestyle changes, adopting healthy lifestyle habits, should be strongly recommended to all people with cardiovascular risk and should be implemented in a progressive and controlled manner . Stop smoking Tobacco consumption is one of the main cardiovascular risk factors and atherosclerotic disease, in addition to being associated with an increased risk of lung, oropharynx and larynx cancer, among others. Cardiovascular risk is proportional to the number of cigarettes smoked, but there is no minimum number below which there is no risk. Even passive smokers are at increased risk. Only total abstinence from tobacco guarantees that this important risk factor is eliminated. There are still no data on the long-term pulmonary and cardiovascular effects of electronic cigarettes and heated tobacco. These may play a role when part of a smoking cessation plan, but it is not yet known whether they are associated with lower cardiovascular risk than conventional cigarettes and other forms of tobacco consumption. Eat a healthy and balanced diet A healthy, balanced diet is critical to maintaining heart health . Foods rich in fiber, such as fruits, vegetables, legumes and whole grains, should be privileged; Foods that are a source of refined carbohydrates, sugars, saturated fats, and salt should be restricted. Doing this, eating routine can help control weight, blood pressure, cholesterol and blood sugar levels. Carefully read the labels on the foods you buy and use it as a guide to check the amount of salt, sugars and fats you eat. Several teas and dietary supplements are credited with lowering cholesterol and blood pressure levels, which are two of the main cardiovascular risk factors that also contribute to the development of atherosclerosis. Always consult your doctor or nutritionist about these supplements before starting any intake, as some can interact with medications and cause undesirable side effects. Practice physical exercise regularly Physical inactivity is a cardiovascular risk factor. Exercising regularly improves blood flow, lowers blood pressure, and reduces the likelihood of several problems that increase the risk of atherosclerosis and cardiovascular disease. The goal is to exercise for at least 30 minutes most days of the week . The most accurate recommendation in the European guidelines is 150-300 minutes of moderate exercise or 75-150 minutes of intense exercise per week. If you cannot fit everything into one session, try breaking it down into 10-minute intervals. Other measures, however small, can help, for example : Use the stairs instead of the elevator; Park the car further away than usual; Reserve some time during lunch to walk around outdoor, even if close to home or work; Do some exercises, suitable for each person, while watching television. Maintain a healthy weight Excess weight is a cardiovascular risk factor. When there is overweight, weight loss can reduce the risk of high blood pressure and high cholesterol , two of the main risk factors for developing atherosclerosis. Maintain blood pressure, cholesterol, and sugar levels within recommended values High blood pressure is mainly associated with an increased risk of stroke, aneurysm, and myocardial infarction. All the aforementioned preventive measures help to control blood pressure, cholesterol, and blood sugar levels. When they are not enough, medical advice is needed to achieve it in other ways. There are no absolute and universal recommended values for blood pressure and cholesterol. The first step is to reach blood pressure values < 140-90 mmHg, with subsequent targets to be defined according to the situations. For example, in patients aged 18-69 years the target for systolic pressure is 120-130 mmHg in most cases. For cholesterol , it is generally intended to achieve LDL values below 100 mg/dL, but in very high-risk patients (eg those who have already had a heart attack) the target may be 55 mg/dL. As for diabetes , the goal is to achieve glycated hemoglobin (HbA1c) values of 7% in most cases, or even 6.5% in patients without cardiovascular disease and not frail. Managing stress Stress is also a cardiovascular risk factor. Getting enough rest, getting quality sleep for a sufficient number of hours, practicing specific relaxation and breathing techniques all help to reduce stress levels. In many cases specific professional help is an asset. Read also: Atherosclerosis and cardiovascular risk factors Atherosclerosis: symptoms and diagnosis Meet the cardiology clinical team from Hospital da Luz network and book your consultation The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
