Atherosclerotic plaque is a concern of many friends. Many friends asked Hua Zi how to reverse the atherosclerotic plaque after the arterial plaque, which drugs can be selected, which drugs Which drug has the strongest effect on plaque reversal?
Hua Zi said that cardiovascular events related to atherosclerotic plaque are one of the leading causes of human death worldwide. In recent decades, many drugs for the treatment of atherosclerotic plaques have been developed, and with the development of imaging, the effect of these drugs on plaques can be evaluated in more detail.
One, the formation of plaques
The formation of atherosclerotic plaques is caused by the long-term effects of smoking, hypertension, hyperlipidemia, diabetes and other pathogenic factors. Endothelial dysfunction and increased endothelial cell permeability allow low-density lipoprotein cholesterol (LDL-C) in the blood to enter the intima.
Macrophages in the intima engulf LDL-C in large quantities, finally forming foam cells and depositing in the endothelium. Vascular smooth muscle cells proliferate around foam cells, forming a fibrous cap that covers their surface, ultimately leading to the formation of atherosclerotic plaques.
And smoking, blood pressure, blood lipids, blood sugar and other pathogenic factors are controllable, as long as timely control, can cause “drawing from the bottom of the pot” for atherosclerotic plaque effect.
Second, the subsidence of plaques
Because foam cells cannot be removed once formed, atherosclerotic plaques were thought to be irreversible for a long time. But it was later found that some people had an increase in the diameter of their arteries, which meant that the plaque had regressed.
Modern imaging technology confirms that regressed plaques are not only smaller in size, but also have altered internal components, reduced lipids, increased density, and the risk of rupture become smaller.
However, not all plaques are reversible. For example, hard plaques and calcified plaques cannot be reversed. However, the plaque itself has a very small probability of rupture and is considered to be stable plaques. block, the danger is very small.
Three, the method of reversing plaque
Non-drug methods:
Adjustment of diet and exercise is an effective intervention for atherosclerotic plaque, but dietary modification alone has limited effect because LDL-C, which is closely related to atherosclerotic plaque, has 70% is produced by the human body itself, while the food eaten can only account for 30%.
Exercise is an effective intervention for atherosclerotic plaques, and in related studies, plaque regression was more pronounced in patients who exercised more. Moreover, studies have shown that athletes are mostly stable hard plaques, while sedentary people are mostly unstable soft plaques, so exercise is an effective non-drug method to reverse plaques.
Medication method:
1. Statins: Statins are mainly used for lipid-lowering therapy, which can reduce LDL-C levels by about 30% to 50%. The degree of cardiovascular risk is related to the degree of LDL-C reduction, so the LDL-C level is a common indicator used to detect the effect of treatment.
Studies found that statins can reduce total plaque volume by up to 20%, while those who did not use statins did not shrink plaque volume , will instead increase. And statins can also increase the fibers in the plaque, reduce lipids and necrosis, and increase the stability of the plaque.
2. Cholesterol absorption inhibitor: Ezetimibe can inhibit intestinal absorption of cholesterol and further reduce LDL-C levels, but studies have found that ezetimibe Cardiovascular risk may be reduced with little effect on plaque volume.
3. PCSK9 inhibitors: The related research is based on the use of statins, combined with PCSK9 inhibitors (elovolumab, alicilidine, etc.) Utuzumab), further reduced the risk of adverse cardiovascular events, and combination with PCSK9 inhibitors resulted in a greater reduction in plaque volume than statins alone.
4. Other lipid-lowering drugs: In related studies, cholesteryl ester transfer protein inhibitor, eicosapentaenoic acid (omega-3 fatty acid), Niacin, fibrate and other drugs have been studied, and no effect on plaque regression has been found.
5. Oral hypoglycemic agents: In diabetic patients, use insulin sensitizers thiazolidinediones (pioglitazone, rosiglitazone), will make the plaques subside more.
To summarize, atherosclerotic plaques cannot be completely eliminated once they have formed, but they can be partially reversed. Increasing physical activity and adhering to statin therapy are the most effective methods for reversing plaque at present. Although other drugs can reduce cardiovascular risk, they cannot replace the role of statin in reversing plaque. The use of the drug needs to be carried out under the guidance of a doctor. If you have any doubts about the use of the drug, please consult your doctor or pharmacist. I am Huazi, a pharmacist. Welcome to follow me and share more health knowledge.