Atherosclerosis - Treatment 

Treating atherosclerosis 

Angiogram

Every year, 61,000 coronary angioplasties are carried out in the UK. If you have angina or have had a heart attack, your doctor may suggest the procedure. Dr Stephen Brecker explains what's involved.

Media last reviewed: 14/11/2013

Next review due: 14/11/2015

Cholesterol lowering foods

Plant sterols and stanols are naturally occurring substances found in some types of food that are known to lower low-density lipoprotein (LDL or ‘bad cholesterol').

Sources of sterols and stanols include:

  • fruits
  • vegetables
  • nuts
  • seeds
  • cereals
  • legumes (such as beans or peas)
  • olive oil
  • vegetable oil

Research suggests that eating 2,000mg of sterols and stanols a day reduces levels of LDL cholesterol by around 10% which, in turn, should reduce the risk of heart disease by around 25%.

The average intake of plant sterols and stanols is about 100-450mg.

There are now a number of commercial products, promoted for their alleged ‘cholesterol-lowering’ effects, which contain higher levels of sterols and stanols. These include special types of yoghurt, milk, margarine, and cheese.

The National Institute of Clinical Excellence (NICE) has stated that there may be a role for these types of products in the treatment of high cholesterol and atherosclerosis.

However, there is not currently enough evidence to confirm whether plant sterols and stanols are an effective method of preventing cardiovascular disease (CVD). Further research is required to clarify the issue.

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for atherosclerosis

If you are at risk of developing a cardiovascular disease (CVD) due to atherosclerosis, you will be advised to change your lifestyle to reduce this risk.

Lifestyle changes include changing your diet and taking more exercise. Read more about preventing atherosclerosis-related CVD.

Medication

There are several medications available to treat many of the underlying causes of atherosclerosis, such as a high cholesterol level and high blood pressure (hypertension).

Depending on your individual circumstances, you may only need to take one medication, or you may need a combination of different medications.

High blood pressure (hypertension)

The most widely used medications for treating high blood pressure are outlined below.

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by blocking the actions of some of the hormones that help to regulate blood pressure.

By stopping these hormones from working, ACE inhibitors reduce the amount of water in your blood, as well as widening your arteries, both of which will lower your blood pressure.

ACE inhibitors are not suitable for:

  • pregnant or breastfeeding women
  • people with conditions that affect the blood supply to their kidneys
  • those with a history of heart disease

The side effects of ACE inhibitors include dizziness, tiredness and headaches

If the side effects of ACE inhibitors become troublesome, angiotensin-2 receptor antagonists may be recommended. They work in a similar way to ACE inhibitors.

Calcium channel blockers

Calcium channel blockers work by relaxing the muscles of your artery walls, which causes your arteries to widen and lowers your blood pressure.

Calcium channel blockers are not recommended for people with a history of heart disease, liver disease or circulation problems.

Side effects include a flushed face, headaches, swollen ankles and dizziness.

You should not drink grapefruit juice if you are taking calcium channel blockers because this can cause your blood pressure to fall.

Thiazide diuretics

Thiazide diuretics work by reducing the amount of water in your blood and widening the walls of your arteries. They are not recommended for pregnant women or people with gout (a type of arthritis where crystals develop inside the joints).

Thiazide diuretics have been known to reduce the level of potassium in your blood, which can interfere with your heart and kidney functions. They can also raise the level of sugar in your blood, which could lead to diabetes.

You will probably be advised to have blood and urine tests every six months so that your potassium and blood sugar levels can be monitored.

A few men reported they could not get or maintain an erection while taking thiazide diuretics, although this side effect resolved once the medication was withdrawn.

Read more about treatment of high blood pressure.

High cholesterol levels

Statins

Statins are a type of medication used to lower blood cholesterol levels. Statins block the effects of an enzyme in your liver called HMG-CoA reductase, which is used to make cholesterol.

Statins sometimes have mild side effects including constipation, diarrhoea and headaches.

Occasionally, statins can also cause muscle pain, weakness and tenderness. You should contact your GP if you experience these symptoms because your dosage may need to be adjusted.

If you have high blood cholesterol, you may need to take statins indefinitely.

Read more about the treatment of high cholesterol.

Preventing blood clots

As many of the serious complications that arise from atherosclerosis, such as a heart attack or stroke, are associated with blood clots, you may be given medication to help reduce the risk of a blood clot.

Antiplatelets

Medications used to prevent blood clots developing are known as antiplatelets. Platelets are tiny particles in the blood that help it to clot. Antiplatelets work by reducing the 'stickiness' of platelets.

You may be advised to take low-dose aspirin which, as well as being a painkiller, has blood-thinning properties.

If testing shows you have a higher than average risk of developing a blood clot, you may be given an additional antiplatelet medication called clopidogrel. Clopidogrel can also be used if you are allergic to aspirin.

Surgery

Surgery may be required if certain important blood vessels become narrowed. These are the:

  • coronary arteries, which supply blood to your heart (narrowing of your coronary arteries can trigger a heart attack)
  • carotid arteries, which supply blood to your brain (narrowing of your carotid arteries can trigger a stroke)

Coronary angioplasty

Coronary angioplasty is a type of surgery used to widen your coronary arteries. A long, flexible plastic tube called a catheter is inserted into a blood vessel and a balloon attached to the catheter is inflated to widen the artery. A small metal tube called a stent is often used to help keep the artery open.

Coronary artery bypass graft

coronary artery bypass graft (CABG) can be used to treat narrowing of the coronary arteries. During a CABG, healthy blood vessel segments (grafts) are taken from other parts of the body in order to bypass the blocked artery.

Segments of vein taken from your legs, arms and chest are used to create a new channel through which blood can be directed around the blocked part of the artery. This enables more blood to get through to the heart muscle.

Carotid arteries

Surgery is usually only recommended to widen the carotid arteries if you have experienced previous symptoms related to a blocked blood supply, such as a stroke or transient ischaemic attack (TIA).

Unlike the coronary arteries, preventative surgery on the carotid arteries is not usually recommended, except in cases where testing shows high levels of narrowing.

This is because studies have found that the benefits achieved in reducing the risks of a stroke in most people without any symptoms are outweighed by the risks associated with surgery. 

Carotid endarterectomy

carotid endarterectomy is the most commonly used method of widening the carotid artery (the main artery in your neck). During the procedure a cut is made into the narrowed part of the artery and the inner lining of the artery is removed, along with any plaque inside it.

Most surgeons sew a patch into the opening to widen this section of the artery. The patch may be taken from a vein in your thigh or it might be synthetic (man-made). Using a patch can reduce your risk of having a stroke after the operation, as well as reducing the likelihood of restenosis (the artery becoming narrowed again).

Carotid angioplasty

A carotid angioplasty uses a balloon catheter (a thin plastic tube with an inflatable balloon at one end). The catheter is inserted into your femoral artery (the body’s main blood vessel) in your groin.

Under the guidance of X-ray, the catheter is threaded up into your femoral artery until it reaches your carotid artery. The balloon is then inflated to around 5mm in diameter. This expands the artery, clearing the narrowing so blood is able to flow through it again.

Carotid angioplasty is a less invasive type of surgery than carotid endarterectomy, so you will experience less post-operative pain and have a faster recovery time.

However, research carried out in 2009 found people who had a carotid angioplasty were more likely to have re-narrowing of the carotid artery compared with those who had a carotid endarterectomy. You should discuss the advantages and disadvantages of both types of surgery with your surgeon.

Extracranial to intracranial bypass

A new type of surgery used to treat blockage of the carotid artery is known as an extracranial to intracranial bypass.

In this type of surgery a section of blood vessel found outside of the skull is diverted and used to bypass the site of the blockage so the blood supply to the brain can be restored.

Extracranial to intracranial bypass is still an evolving field of treatment and it is unclear how effective or safe it may be in the long-term.

If you are offered extracranial to intracranial bypass surgery it may be in the context of a clinical trial.




Page last reviewed: 30/04/2012

Next review due: 30/04/2014

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