Atherosclerosis Treatment

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If you have a diagnosis of atherosclerosis, work with your healthcare team to set up a treatment plan that works for you based on your lifestyle, your home and neighborhood environment, and your culture. Your 10-year or lifetime risk assessment is a good way to start the conversation.

Heart-healthy lifestyle changes

Heart-healthy living is very important for preventing and treating atherosclerotic plaque buildup throughout your lifetime.

Steps for a healthy lifestyle include:

• Choose heart-healthy foods, such as the DASH (Dietary Approaches to Stop Hypertension) eating plan. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, sodium (salt), and added sugars.
• Be physically active. Routine physical activity can help manage risk factors such as high blood cholesterol, high blood pressure, overweight and obesity. Adults should engage in a total of 150 minutes or more per week of moderate physical activity or 75 minutes per week of vigorous physical activity. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
• Aim for a healthy weight. Losing just 3% to 5% of your current weight can help you manage some coronary heart disease risk factors, such as high blood cholesterol and diabetes. Greater amounts of weight loss can also improve blood pressure readings.
• Limit how much alcohol you drink. Drinking less is better for health than drinking more. Men should limit their intake to 2 drinks or less in a day. Women should drink 1 drink or less per day.
• Manage stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
• Quit smoking and avoid secondhand smoke. Visit Smoking and Your Heart and Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Talk to your doctor if you vape. There is scientific evidence that nicotine and flavorings found in vaping products may damage your heart and lungs.
• Get enough good-quality sleep. The recommended amount for adults is 7 to 9 hours of sleep a day.

Medicines can help manage risk factors and treat atherosclerosis or its complications. Your doctor may also prescribe medicines to treat other medical conditions, such as high blood pressure, that can worsen plaque buildup.

Medicines often used to treat atherosclerosis or related conditions are listed below.

• ACE inhibitors and beta blockers help lower blood pressure and lower the heart's workload.
• Anti-platelet or anti-clotting medicines may help reduce risk of complications for some people who have atherosclerosis. Aspirin is not recommended for most people.
• Calcium channel blockers lower blood pressure by relaxing blood vessels.
• Medicines to control blood sugar, such as empagliflozin, canagliflozin, and liraglutide, help lower your risk for complications if you have atherosclerosis and diabetes.
• Metformin helps control plaque buildup if you have diabetes.
• Nitrates, such as nitroglycerin, dilate your coronary arteries and relieve or prevent chest pain from angina.
• Ranolazine treats coronary microvascular disease and the chest pain it may cause.
• Statins treat unhealthy blood cholesterol levels. Your doctor may recommend a statin if you have a higher risk for coronary heart disease or stroke or if you have diabetes and are between ages 40 and 75.
• Other cholesterol-lowering medicines, such as ezetimibe, PCSK9 inhibitor, bempedoic acid, and omega-3 fatty acids, may be used if you are unable to take statins or when statins have not worked to treat unhealthy blood cholesterol and triglyceride levels.
• Thrombolytic medicines, sometimes called clot busters, may be used to treat blood clots resulting from atherosclerosis. These medicines can dissolve blood clots that block arteries, causing a stroke, heart attack, mesenteric Ischemia or other problems. Ideally, the medicine should be given as soon as possible.

Some dietary supplements and foods have shown signs in studies that they may help manage atherosclerosis risk factors. Talk with your doctor about possible benefits of nutritional supplements and particular foods. Be sure to discuss any nutritional supplements you’re already taking. Some may interfere with other treatments or cause side effects. Read more about use of dietary supplements in cholesterol management.

You may need a procedure, heart surgery, or other types of surgery to treat disease resulting from plaque buildup. The type of procedures or surgery depends on arteries affected.

• Percutaneous coronary intervention (PCI) opens coronary arteries that are narrowed or blocked by the buildup of plaque. A small mesh tube called a stent is usually implanted after PCI to prevent the artery from narrowing again.
• Coronary artery bypass grafting (CABG) improves blood flow to the heart by using normal arteries from the chest wall or veins from the legs to bypass the blocked arteries. Surgeons typically use CABG to treat people who have severe plaque buildup in arteries in the heart. Bypass grafting can also treat arteries in other parts of the body, such as the arteries leading to the intestines.
• Transmyocardial laser revascularization or coronary endarterectomy treats severe angina associated with coronary heart disease when other treatments are too risky or did not work.
• Carotid endarterectomy treats carotid artery disease. Other treatment options for this disease may include angioplasty and carotid artery stenting.
• Weight-loss surgery may help reduce inflammation leading to plaque buildup in people who have severe obesity.
• Angioplasty opens narrowed or blocked arteries. Doctors may use angioplasty to treat peripheral artery disease affecting the legs, in the arteries of the heart to treat coronary heart disease, or in the neck to treat carotid artery disease. Your doctor may inflate a small balloon in the artery to help flatten the plaque. Sometimes the balloon is coated with medicine to help the artery heal. Your doctor may also insert a small mesh tube called a stent to reduce the chances of the artery narrowing again.

• To help relieve symptoms of peripheral artery disease, your doctor will recommend a supervised exercise program in a clinic or a home-based exercise program. Most home programs include health coaching, activity monitors, or regular check-ins with a coach by telephone. Talk with your doctor regularly about your progress.
• If you have had a complication from atherosclerosis, your doctor may recommend a cardiac rehabilitation program.
• Behavioral therapy or coaching support helps many people stick with heart-healthy lifestyle changes. Counseling may also improve people’s quality of life after they’ve had a complication.