Atherosclerosis is a condition characterized by the buildup of plaques within the arterial walls, leading to both narrowed and hardened arteries. This process can result in serious cardiovascular events such as heart attacks and strokes. One of the key factors contributing to atherosclerosis is elevated levels of low-density lipoprotein cholesterol (LDL-C).

Cholesterol-lowering medications, particularly statins, play a crucial role in managing atherosclerosis and reducing the risk of cardiovascular events. The American College of Cardiology and the American Heart Association recommend high-intensity or maximally tolerated statin therapy for patients with clinical atherosclerotic cardiovascular disease (ASCVD) to lower LDL-C levels by at least 50%. This recommendation is based on robust evidence demonstrating that greater reductions in LDL-C are associated with significant decreases in the risk of subsequent cardiovascular events.^[1]

For patients at very high risk of ASCVD, such as those with a history of multiple major ASCVD events, the guidelines suggest considering the addition of non-statin therapies like ezetimibe if LDL-C levels remain above 70 mg/dL despite maximally tolerated statin therapy. This approach aims to achieve more intensive LDL-C lowering, further reducing the risk of adverse cardiovascular outcomes.^[1]

In addition to medication, lifestyle modifications such as diet and exercise are essential components of atherosclerosis management. A meta-analysis has shown that intensive lifestyle changes, including a low-fat diet and regular physical activity, can significantly reduce coronary and carotid atherosclerotic burden. Regular physical activity improves endothelial function, reduces systemic inflammation, and enhances lipid profiles, thereby mitigating the progression of atherosclerosis.^[1-3]

The American Heart Association emphasizes that physical activity can prevent and treat many established atherosclerotic risk factors, including elevated blood pressure, insulin resistance, and obesity. Moreover, dietary interventions such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains, and healthy fats, have been shown to reduce atherosclerosis progression and improve cardiovascular outcomes.^[4-5]

Adherence to lipid-lowering therapy and lifestyle modifications is essential for achieving optimal LDL-C levels and reducing ASCVD risk. Strategies to improve adherence include patient education, regular follow-up evaluations with a patient’s provider, and the use of reminder systems. Additionally, newer lipid-lowering agents with less frequent dosing schedules may enhance adherence and improve outcomes.^[6]

In summary, cholesterol-lowering medications, particularly statins, are vital in the management of atherosclerosis. Combining these medications with lifestyle modifications such as diet and exercise, as recommended by the American College of Cardiology and the American Heart Association, can significantly reduce the risk of cardiovascular events in patients with elevated LDL-C levels.

References

1. Meta-Analysis of the Effects of Lifestyle Modifications on Coronary and Carotid Atherosclerotic Burden.
2. Endurance Exercise Ameliorates Western Diet-Induced Atherosclerosis Through Modulation of Microbiota and Its Metabolites. Huang WC, Tung CL, Yang YSH, et al. Scientific Reports. 2022;12(1):3612. doi:10.1038/s41598-022-07317-x.
3. An Essential Role for Diet in Exercise-Mediated Protection Against Dyslipidemia, Inflammation and Atherosclerosis in ApoE⁻/⁻ Mice. Cesar L, Suarez SV, Adi J, et al.PloS One. 2011;6(2):e17263. doi:10.1371/journal.pone.0017263.
4. Effect of Intensive Lifestyle Changes on Endothelial Function and on Inflammatory Markers of Atherosclerosis.
5. Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity).
6. Regular Physical Exercise and Low-Fat Diet. Effects on Progression of Coronary Artery Disease. Schuler G, Hambrecht R, Schlierf G, et al.Circulation. 1992;86(1):1-11. doi:10.1161/01.cir.86.1.1.

Jhamnani S, Patel D, Heimlich L, et al.The American Journal of Cardiology. 2015;115(2):268-75. doi:10.1016/j.amjcard.2014.10.035.

Dod HS, Bhardwaj R, Sajja V, et al.The American Journal of Cardiology. 2010;105(3):362-7. doi:10.1016/j.amjcard.2009.09.038.

Thompson PD, Buchner D, Pina IL, et al.Circulation. 2003;107(24):3109-16. doi:10.1161/01.CIR.0000075572.40158.77.