TREATMENT FOR ATHEROSCLEROSISThe treatment goals for patients with coronary artery atherosclerosis are to relieve symptomsof CAD and to prevent future cardiac events, such as unstable angina, AMI, and death. MEDICATION SURGERYMEDICATION 1. Cholesterol lowering Statin - Statins slow down the production of "bad" cholesterol (LDL) in the liver. Statins cause LDL levels to fall dramatically -- by up to 60%. Levels of HDL or "good" cholesterol also increase. Statins are the best medications for lowering bad cholesterol, and are the most widely used cholesterol drugs. These drugs can also help reduce the level of triglycerides. - Taking a statin for a year or longer can even shrink atherosclerosis plaques slightly. This reversal of atherosclerosis surprised many experts who believed that atherosclerosis was irreversible. - One way statins may reduce the chance of blood clots originating from a plaque is by "cooling off" inflammation inside plaques. Inflammation is responsible for plaque rupture, which causes heart attacks and strokes. - Reversing atherosclerosis completely isnt yet possible. But taking a statin reduces the risk of complications from atherosclerosis considerably. For this reason, statins are often central to atherosclerosis treatment. - lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). Scientifically, statins are referred to as HMG- CoA reductase inhibitors. Fibrate - Fibrates are drugs that reduce triglyceride levels. Triglycerides are non- cholesterol fats that contribute to atherosclerosis. - There are two fibrates currently used Gemfibrozil Fenofibrate
- Fibrates also increase HDL or "good" cholesterol slightly. For people with high triglycerides and a low HDL level (but whose LDL level is OK), fibrates help lower the risk for heart disease.2. Anti-hypertension ACE inhibitor - Angiotensin II is a very potent chemical that causes the muscles surrounding blood vessels to contract, thereby narrowing the vessels. The narrowing of the vessels increases the pressure within the vessels causing high blood pressure (hypertension). Angiotensin II is formed from angiotensin I in the blood by the enzyme angiotensin converting enzyme (ACE). ACE inhibitors are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, the blood vessels enlarge or dilate, and blood pressure is reduced. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed. Calcium channel blocker - By dilating the arteries, CCBs reduce the pressure in the arteries. This makes it easier for the heart to pump blood, and, as a result, the heart needs less oxygen. By reducing the hearts need for oxygen, CCBs relieve or prevent angina. CCBs also are used for treating high blood pressurebecause of their blood pressure-lowering effects. CCBs also slow the rate at which the heart beats3. Anti-platelet Aspirin - Antiplatelet agents help reduce the number of acute coronary events. - The risk of myocardial ischemic events in patients with ACS has been shown to be reduced by means of platelet inhibition with the use of aspirin.
SURGERY 1. Coronary Angioplasty - Coronary angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and blowing up a tiny balloon where your artery is clogged to help widen the artery. - Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease the chance of it narrowing again. Some stents are coated with medication to help keep your artery open (drug- eluting stents), while others are not (bare-metal stents). - Angioplasty can improve some of the symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart. 2. Coronary Bypass Surgery - Coronary bypass surgery is a procedure that restores blood flow to your heart muscle by diverting the flow of blood around a section of a blocked artery in your heart. Coronary bypass surgery uses a healthy blood vessel taken from your leg, arm, chest or abdomen and connects it to the other arteries in your heart so that blood is bypassed around the diseased or blocked area. After a coronary bypass surgery, normal blood flow is restored. Coronary bypass surgery is just one option to treat heart disease. - Coronary bypass surgery can help reduce your risk of having a heart attack. For many people who have coronary bypass surgery, symptoms such as chest pain and shortness of breath are reduced after having the surgery.REFERENCES 1. http://www.hcc.bcu.ac.uk/physiology/root/pharmacology/statins%20article.pdf 2. http://www.medicinenet.com 3. http://www.mayoclinic.com