From the Guidelines
Maintaining normal lipid levels is crucial, but existing atherosclerotic plaques may not significantly decrease without aggressive lipid-lowering therapy, which can help reduce morbidity and mortality by slowing or halting plaque progression and even promoting regression of existing plaques, thereby improving quality of life. To manage atherosclerosis and reduce the risk of adverse outcomes, a comprehensive approach is necessary, including medication therapy, lifestyle modifications, and control of other risk factors. According to the 2024 recommendations on the optimal use of lipid-lowering therapy in established atherosclerotic cardiovascular disease and following acute coronary syndromes 1, lipid-lowering therapy (LLT) is essential for reducing the burden of atherosclerotic cardiovascular disease (ASCVD).
The 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1 provide specific recommendations for lipid-lowering therapy in patients with atherosclerotic peripheral arterial and aortic diseases (PAAD), including an ultimate LDL-C goal of <1.4 mmol/L (55 mg/dL) and a >50% reduction in LDL-C vs. baseline. Statins are recommended in all patients with PAAD, and if the target LDL-C level is not achieved on maximally tolerated statins and ezetimibe, treatment with a PCSK9 inhibitor is recommended to achieve target values. Additionally, lifestyle modifications such as a Mediterranean or DASH diet, regular exercise of 150 minutes weekly, smoking cessation, and control of other risk factors like hypertension and diabetes are essential for managing atherosclerosis and reducing the risk of adverse outcomes. Regular follow-up with your healthcare provider is necessary to monitor progress and adjust treatment as needed, with the goal of minimizing morbidity and mortality and maximizing quality of life.
Key aspects of managing atherosclerosis include:
- Medication therapy: statins (e.g., atorvastatin 10-80mg daily or rosuvastatin 5-40mg daily), ezetimibe, PCSK9 inhibitors, and bempedoic acid
- Lifestyle modifications: Mediterranean or DASH diet, regular exercise, smoking cessation
- Control of other risk factors: hypertension, diabetes
- Regular follow-up with your healthcare provider to monitor progress and adjust treatment as needed, with a focus on minimizing morbidity and mortality and maximizing quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Atherosclerotic Plaques and Lipid Management
- Atherosclerotic plaques in arteries are a result of elevated low-density lipoprotein cholesterol (LDL-C) levels, which is a modifiable cause of atherosclerotic cardiovascular disease 2, 3.
- Maintaining normal lipid levels is crucial in reducing the risk of cardiovascular events, and statin therapy has been shown to reduce serum cholesterol and morbidity and mortality of cardiovascular disease 4.
- Lipid-lowering therapies, including statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, can help reduce circulating levels of atherogenic particles and ameliorate the risk of atherosclerotic cardiovascular disease (ASCVD) 5.
Effect of Lipid Management on Atherosclerotic Plaques
- Statins have been shown to play a role in plaque regression with reduction in lipid content, and further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification 4.
- PCSK9 inhibitors can reduce LDL-C by 50-60% above that achieved by statin therapy alone, and may reduce cardiovascular events and all-cause mortality in patients with clinical ASCVD 5.
- Current guidelines recommend statins as the backbone of therapy, with PCSK9 inhibitors and other lipid-lowering agents used in addition to statins for high-risk patients who are not achieving treatment goals 2, 6.
Importance of Maintaining Normal Lipid Levels
- Maintaining normal lipid levels is essential in reducing the risk of cardiovascular events, and can help stabilize atherosclerotic plaques and reduce the risk of acute coronary events 3, 4.
- Current guidelines emphasize the importance of identifying patients at very high cardiovascular risk and treating to achieve LDL-C levels as low as possible, with a goal of <1.4 mmol/L (<55 mg/dL) in patients with very high-risk cardiovascular disease 2.