Nowadays, many people find that they have carotid plaque during the physical examination, and they can't help but worry - will the plaque fall off at any time and block the blood vessels?There are already plaques, can they be "rescued"?What are the effective ways to reverse it?Cardiovascular medicine experts will introduce you to the prevention and treatment of plaque.
Be wary of "ticking time bombs" on the carotid arteries
If you touch the sides of your neck with your hands, you can clearly feel the blood vessels beating, which is the carotid artery. The carotid artery is narrower than other arteries and has a "Y" shaped crossing near the head and neck. Blood flows through the carotid arteries throughout the body, especially at the "Y" junction, which creates more pressure. If the blood is not pure, then it is easy to deposit impurities there, and over time "plaque" can form. Therefore, we often think of the carotid artery as a "window" to reflect the health of the arteries and vessels throughout the body.
Many people are found to have carotid plaque during physical examination, which indirectly reflects the degree of atherosclerosis throughout the body.
Although we can't feel carotid plaque with our hands, and we don't feel uncomfortable in our necks, there is a strong link between carotid plaque and ischemic stroke – studies have found that people with carotid plaque are 2-3 times more likely to have ischemic stroke than those who don't!At the same time, when screening people at high risk of stroke, more than 2 to 3 people were found to have carotid plaque. This is enough to show that the combination of carotid plaque will significantly increase the risk of cardiovascular events, and everyone should actively prevent and treat carotid plaque.
Lipid-lowering drugs are the "killer feature" to deal with plaque
Can plaques be reversed?The key to carotid plaque is to control blood lipids. By actively improving lifestyle habits and rationally applying lipid-lowering drugs, the medial and medial thickening of the carotid artery can be effectively slowed down and reduced, and the unstable plaque can be transformed into stable plaque, thereby reducing the probability of cerebral infarction.
The study noted that there is sufficient high-quality evidence to support that "the use of lipid-lowering drugs to minimize low-density lipoprotein cholesterol (LDL-C) levels can stabilize and resolve coronary plaque." ”
Statin is one of the most commonly used lipid-lowering drugs in clinical practice, which can significantly reduce LDL-C levels. A number of studies have also confirmed that the rational use of statin lipid-lowering drugs can help patients with chronic coronary heart disease or acute coronary syndrome stabilize plaques, or even allow plaques to gradually regress. Even if the patient has already had a coronary event, it is not too late to make amends, and early use of statins to lower LDL-C still has a positive effect.
When it comes to the question of dosage, studies have also pointed the way: high-intensity statins** are more effective than low-intensity statins**: atorvastatin 80mg can significantly delay plaque progression compared to pravastatin 40mg.
Are there any alternatives to statins?
At present, among the recommended lipid-lowering drugs in China, statins are still second to none. However, some patients still have high blood lipid levels after taking statin drugs**. If statins don't work, is there any other option?
Clinical studies have found that if the lipid-lowering effect is not good after the application of 1 statin**, the dosage will generally not be increased to 2 or 3 tablets, because after the statin dose is doubled, the lipid-lowering effect is not doubled - only about 6% increase, while the risk of *** has skyrocketed. Therefore, it is better to combine other types of cholesterol-lowering drugs, such as statins with ezetimibe. Ezetimibe inhibits the reabsorption of LDL and cholesterol through the intestine, thereby further enhancing the lipid-lowering effect, and is relatively small.
In addition, in recent years, PCSK9 inhibitors (alixirumab injection and evolocumab injection) marketed in China have shown a strong cholesterol-lowering effect, bringing a new dawn to patients with hyperlipidemia. Another example is beperidicic acid, an ATP citrate lyase inhibitor that reduces plasma LDL-C levels and major adverse cardiovascular events in statin-intolerant patients.
It can be seen that when the effect of statin drugs alone** is not significant, non-statin drugs (especially PCSK9 inhibitors and ezetimibe) can be combined to reduce LDL-C and promote plaque regression and stabilization.
Improving lifestyle" cannot be loosened.
The study concluded that it was "unclear" whether lifestyle interventions would resolve or stabilize coronary plaque. Some people wonder if we can stop eating and exercising healthily, but even if we can't reverse the plaque by actively improving our lifestyle habits, it is still beneficial, at least it can help us prevent and manage risk factors such as atherosclerotic disease.
For patients with carotid plaque who are asymptomatic and have no risk factors, if they can adhere to a reasonable diet, exercise appropriately, quit smoking and limit alcohol, and control their weight, they can ensure that low-density lipoprotein cholesterol (LDL-C) <26mmol L, there is no need to take lipid-lowering drugs.
Wen Wangfang (Beijing Hospital).