From the Guidelines
The management of arteriosclerosis should focus on lifestyle modifications and medications to slow disease progression and reduce cardiovascular risk, with a priority on statin therapy and lifestyle modification to address modifiable risk factors, as recommended by the most recent guidelines 1. The approach to managing arteriosclerosis involves several key components:
- Lifestyle modifications, including a heart-healthy diet low in saturated fats and sodium, regular moderate exercise (at least 150 minutes weekly), maintaining a healthy weight, quitting smoking, and limiting alcohol consumption.
- Medications, with statins such as atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily) being first-line to lower LDL cholesterol to target levels based on risk stratification, as supported by recent recommendations 1.
- Antihypertensives are prescribed if blood pressure exceeds 130/80 mmHg, with ACE inhibitors (like lisinopril 10-40 mg daily) or ARBs often preferred, based on guidelines for managing patients with atherosclerotic cardiovascular disease 1.
- Antiplatelet therapy with low-dose aspirin (75-100 mg daily) may be recommended for secondary prevention, as suggested by guidelines for patients with extracranial carotid and vertebral artery disease 1.
- For diabetes management, metformin is typically the first-line agent, with a target HbA1c below 7%, as part of comprehensive secondary prevention measures 1. Regular monitoring of lipid profiles, blood pressure, and blood glucose is essential to adjust treatment plans accordingly and ensure that patients are meeting their target levels, which is crucial for reducing the risk of cardiovascular events, as emphasized in recent discussions on practical solutions for implementing blood cholesterol guidelines 1.
Key considerations in the management of arteriosclerosis include:
- The importance of addressing modifiable risk factors through lifestyle modification and optimal guideline-directed medical therapy, as highlighted in a recent evidence-based guide for primary care physicians 1.
- The role of newer lipid-lowering therapies, such as ezetimibe, bempedoic acid, and PCSK9 inhibitors, for patients at very high and extremely high cardiovascular risk, as discussed in the 2024 recommendations on the optimal use of lipid-lowering therapy 1.
- The need for patient-centered care and individualized treatment plans that account for patient risk factor profiles, cost, tolerance, and other clinical characteristics, as well as guidance from regulatory agencies, to improve access and adherence to lipid-lowering therapy 1.
From the Research
Management Approach for Arteriosclerosis
The management approach for arteriosclerosis involves a combination of lifestyle modifications and medical therapies.
- Lifestyle modifications include smoking cessation, exercise therapy, and dietary changes to reduce saturated fat intake 2.
- Medical therapies may include:
- Cholesterol reduction using statins 3, 4
- Antiplatelet therapy with aspirin 5, 4, 6
- Anticoagulation therapy
- Peripheral vasodilators
- Blood pressure management using agents such as angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers 3, 4, 6
- Combination therapy with a statin, ACE inhibitor, and calcium channel blocker 3
Benefits of Combination Therapy
Combination therapy with aspirin, a statin, and blood pressure-lowering agents has been shown to reduce the risk of vascular morbidity and mortality in patients with coronary artery disease 4.
- A study found that combination therapy with aspirin, a statin, and ≥1 blood pressure-lowering agent was associated with a lower risk of myocardial infarction, ischemic cerebrovascular accident, and all-cause mortality compared to the absence of combination therapy 4.
- Another study found that triple therapy with a statin, ACE inhibitor, and calcium channel blocker was associated with a significant reduction in major cardiovascular events 3.
Underutilization of Evidence-Based Therapies
Despite the benefits of combination therapy, there is evidence of underutilization of evidence-based therapies in patients with coronary artery disease 6.
- A study found that older persons with coronary artery disease in an academic nursing home were often not treated with aspirin, beta blockers, ACE inhibitors, or lipid-lowering drugs, despite no contraindications to their use 6.
- This underutilization may contribute to poor outcomes in patients with arteriosclerosis, highlighting the need for increased awareness and adherence to evidence-based guidelines 5, 6.