Treatment of arteriosclerosis

Summary. Arteriosclerotic disease develops over the course of several decades. Currently, a number of therapies are at hand to effectively stop this process and avoid complications of arteriosclerosis. Among the non-pharmacologic options, a balanced diet and physical activity predominate. A modern dietary plan offers a variety of tasty servings rich in fresh fruit and vegetables, cereals, fish, and poly-unsaturated fatty acids. The value of regular physical activity is demonstrated by the finding that an increase in exercise capacity ("cardiorespiratory fitness") by only one metabolic equivalent already reduces cardiovascular risk by 20-25 %. Regarding pharmacologic therapy, convincing data are available for cholesterol synthase inhibitors ("statins"), some substances which influence the renin-angiotensin system (such as ramipril), and platelet aggregation inhibitors. Statins produce a 20 to 30 % reduction of cardiac death, myocardial infarction, and stroke. In patients with increased cardiovascular risk, the beneficial action of statins is also evident in subjects with low baseline cholesterol values. Apart from the cholesterol-lowering effects, anti-inflammatory and other vasoprotective mechanisms are involved. The angiotensin-converting enzyme inhibitor ramipril has demonstrated that even independent of blood-pressure lowering, cardiovascular events (cardiac death, myocardial infarction, stroke) are substantially reduced in high-risk patients. The effect is in the same order as that of statins. In patients with left-ventricular hypertrophy, the angiotensin-receptor antagonist losartan produces a notable reduction in stroke, independent of its blood-pressure lowering action. Finally, the platelet aggregation inhibitors aspirin and clopidogrel have proven benefit in secondary prevention and, in the case of aspirin, also in primary prevention in cardiovascular high-risk patients. The anti-arteriosclerotic properties of other substances are actively investigated, including calcium channel blockers, betablockers, and novel drug classes. From the medical point of view, a broader use of the well-proven and effective therapies of arteriosclerosis and its complications is clearly warranted.