What is the role of medications in the treatment of atherosclerotic cardiovascular risk in adults

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Answer

The goals of pharmacotherapy are to reduce morbidity and mortality and to prevent complications. Prevention and treatment of atherosclerosis requires risk factor control, including the medical treatment of hypertension, diabetes mellitus, and cigarette habituation.

Advances in the understanding of the vascular biology of atherosclerosis raise the possibility of novel therapies that address more directly the various aspects of endothelial dysfunction and the role of endothelial dysfunction in atherogenesis. Potential cellular targets include vascular smooth muscle cells, monocyte/macrophage cell lines, platelets, and endothelial cells. Evidence shows that antiplatelet agents, antioxidant therapies, amino acid supplementation, angiotensin converting enzyme (ACE) inhibitors, and angiotensin-receptor blockers may be able to prevent or slow the progression of atherosclerosis.

Combination therapy in the future may allow for the achievement of greater low-density lipoprotein cholesterol (LDL-C) lowering, with associated cardiovascular benefit. In one example of such therapy, treatment with Vytorin, which combines ezetimibe (decreases small intestinal absorption of cholesterol) with simvastatin, produced benefit in cardiovascular morbidity and mortality over and above that demonstrated for simvastatin alone. [107] PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors (eg, alirocumab, evolocumab) dramatically lower LDL-C when added to maximally tolerated statin therapy. Studies are under way to determine if outcomes (eg, cardiovascular morbidity and mortality) will improve. [109, 110, 111]

Patients who are discharged on antilipid medications that were begun in the hospital tend to stay on the therapy and to derive significant reduction in the recurrent cardiac event rate. The American Heart Association (AHA) has promulgated its Get With the Guidelines program, which involves an Internet-based checklist of discharge medications to ensure that coronary artery disease (CAD) patients are started on aspirin, beta-blockers, ACE inhibitors, and statins (if needed) in the hospital. [112]


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