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Published on: November 10, 2017
Lipid-altering therapies and the progression of atherosclerotic disease
1Department of Chemical Pathology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK. Anthony.Wierzbicki@kcl.ac.uk
Insights
Lipid-lowering therapies, particularly statins, slow atherosclerosis progression. Optimizing the entire lipid profile, potentially with nicotinic acid or HDL-like particles, may offer additional benefits in managing cardiovascular disease.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Pharmacology
Background:
- Lipids are critical in atherosclerosis development.
- Lipid-lowering therapies have been investigated for 30 years in coronary heart disease.
- Atherosclerosis progression is monitored using carotid intima-media thickness, coronary lumen diameter, and intravascular ultrasound.
Purpose of the Study:
- To review the impact of lipid-lowering therapies on atherosclerosis progression in coronary and carotid arteries.
- To explore the potential benefits of optimizing the complete lipid profile beyond statin therapy alone.
Main Methods:
- Review of existing literature on lipid-lowering therapies and atherosclerosis progression.
- Analysis of data from studies measuring carotid intima-media thickness, coronary lumen diameter, and intravascular ultrasound.
- Examination of the effects of statins, fibrates, nicotinic acid, and high-density lipoprotein (HDL)-like particles.
Main Results:
- Statins are the primary therapy for reducing atherosclerosis and cardiovascular events, including stroke and transient ischemic attacks.
- Statins demonstrate benefits in patients undergoing carotid endarterectomy.
- Data on fibrates and nicotinic acid for reducing atherosclerosis progression are less extensive.
- Recent studies suggest adding nicotinic acid to statin therapy or infusing HDL-like particles can reduce or even reverse atherosclerosis progression.
Conclusions:
- Lipid-lowering therapies play a crucial role in managing atherosclerosis.
- Optimizing the entire lipid profile may provide additive benefits to statin therapy.
- Future management of carotid stenosis is likely to be drug-focused and personalized to individual lipid profiles, with interventions reserved for advanced disease.
Abstract:
Lipids play a key role in the progression of atherosclerosis, and lipid-lowering therapies have been studied for 30 years in coronary disease. Measurement of the progression of atherosclerosis through carotid intima-media thickness, coronary mean lumen diameter, and, mostly recently, intravascular ultrasound is generally accepted. This article reviews the role of lipid-lowering therapies in changing the rate of atherosclerosis progression in the coronary and carotid circulations. Statins are the primary therapy used to reduce atherosclerosis and cardiovascular events, including strokes and transient ischemic attacks, and have benefits in reducing events in patients undergoing carotid endarterectomy. In contrast, data for other agents, including fibrates and nicotinic acid, in reducing the progression of atherosclerosis are less extensive and not as well known. There is increasing interest in optimizing the whole lipid profile, as this might deliver extra benefits over and above statin therapy alone. Initial proof of this concept has recently come from studies that measured the progression of atherosclerosis and showed that adding nicotinic acid to statin therapy and, more directly, infusion of high-density lipoprotein-like particles reduced progression and indeed might induce regression of the disease. It is likely that the management of significant carotid stenosis will become ever more drug focused and will be customized to the lipid profile of each patient with intervention reserved only for late-stage symptomatic disease.
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