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Doctors' Answers to "Frequently Asked Questions" - Atherosclerosis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Atherosclerosis of the Heart
Question: Is there any drug that can reverse the process (not just prevent) of atherosclerosis of heart?

Answer: Atherosclerotic heart disease is an all too common problem experienced by many patients. There are many so-called "risk factors" for the development of coronary artery disease, including a history of smoking, diet high in fat and calories, diabetes mellitus, being of male gender, and most importantly, a significant family history of disease. There are many medications and therapies, as you elude to, that can prevent progression of atherosclerotic heart disease and its complications (angina, and myocardial infarcts ("heart attacks")). There is no medication available at this time, however, that can actively reverse atherosclerosis of the vessels that supply the heart (or any other organ, for that matter). Angioplasty (physically opening the artery with a balloon), or removal of atherosclerotic plaques with a catheter device can be used to open up diseased vessels mechanically, but the plaques are physically altered in these instances, and not reversed. However, depending on risk factors, proper medication therapy can keep the progression of plaques in check, and in this setting the plaques can slowly be remodeled by the body and become less functionally significant. In addition, the non-diseased vessels have time to "pick up the slack" and supply the area supplied by the diseased vessel, and avoid problems should the plaque-containing vessel get worse. However, if the patient is a smoker, and continues to consume a poor diet, and/or has a significant family history, such remodeling of a plaque is less likely to occur. Medication alone, however, in response to your question, cannot reverse atherosclerotic heart disease. Consulting with your physician, however, can provide you with the information necessary to initiate a good "heart smart" diet, an appropriate exercise plan, a smoking cessation program if needed, and an appropriate medication regimen that will optimize your chances of avoiding complications of atherosclerotic disease of the coronary arteries.

Question: Please let me know the curative as distinguished from preventive effect of drugs like Pravachol, Niacin, Coenzyme Q 10, etc., on atherosclerosis of heart. Please also let me know if there is any other drug that has curative effect, that is, effect of reversing the process of atherosclerosis.

Answer: We really don't know if any of these are capable of reversing atherosclerosis. There are times that patients clearly have reversible lesions, but the reason is unclear. There are advocates that any cholesterol lowering agent will do this. Others say that increasing the HDL, the so-called good cholesterol is the only agent capable of reversing damage to arteries. There are currently studies in progress using several agents such as you have mentioned as well as diet, exercise, Vitamin E, etc., to see which agents might reverse lesions-tune in later.

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