Nowadays, many people find that they have carotid artery plaque during physical examination, and they can't help but worry - will the plaque fall off and block the blood vessels at any time?

There are already plaques, can they be “rescued”?

What are the effective methods of reversal?

Cardiovascular medicine experts will introduce to you the prevention and treatment of plaque.

  Beware of the “ticking time bomb” on the carotid artery

  If you touch both sides of your neck with your hands, you can clearly feel the blood vessels beating. This is the carotid artery.

Compared with other arteries, the carotid artery is narrower and has a "Y"-shaped intersection near the head and neck.

Blood throughout the body flows through the carotid arteries, especially at the "Y" intersection, which creates greater pressure.

If the blood is not pure, impurities will easily accumulate here, forming "plaques" over time.

Therefore, we often regard the carotid artery as a "window" that reflects the health of the arteries and blood vessels throughout the body.

  Many people are found to have carotid artery plaque during physical examination, which indirectly reflects the degree of systemic atherosclerosis.

  Although we cannot feel the carotid artery plaque with our hands, and we will not feel uncomfortable in the neck because of it, there is a close connection between carotid artery plaque and ischemic stroke - research has found that people with carotid artery plaque People with plaque in their arteries are up to 2-3 times more likely to have an ischemic stroke than those without!

At the same time, when screening people at high risk of stroke, it was also found that more than two-thirds of people had carotid artery plaque.

This is enough to show that the combination of carotid artery plaque will significantly increase the risk of cardiovascular events, and everyone must actively prevent and treat carotid artery plaque.

  Lipid-lowering drugs are the “killer weapon” against plaques

  Can plaque be reversed?

The key to treating carotid plaque is controlling blood lipids.

By actively improving living habits and rationally applying lipid-lowering drugs, we can effectively slow down and reduce the thickening of the intima and media of the carotid artery, promote the transformation of unstable plaques into stable plaques, 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 reduce coronary plaques."

  Statins are one of the most commonly used lipid-lowering drugs in clinical practice and can significantly reduce LDL-C levels.

Multiple 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 and even cause plaques to gradually disappear.

Even if the patient has already suffered a coronary event, it is not too late to make amends. Early application of statins to lower LDL-C still has a positive effect.

  Regarding the issue of dosage, relevant studies have also pointed out the direction: high-intensity statin treatment is more effective than low-intensity statin treatment: compared with pravastatin 40mg, atorvastatin 80mg can delay plaque progression more significantly.

  Are there alternatives to statins?

  At present, among the recommendations for lipid-lowering drug treatment in my country, statins are still the most recommended.

However, some patients still have high blood lipid levels after statin treatment.

If the statin route doesn't work, are there any other options?

  Clinical studies have found that if the lipid-lowering effect is not good after one tablet of statin treatment, the dosage is generally not increased to 2 or 3 tablets, because after doubling the statin dose, the lipid-lowering effect does not double - it only increases by about 6%. And the risk of side effects has skyrocketed.

Therefore, a better approach is to combine it with other types of cholesterol-lowering drugs, such as statins combined with ezetimibe.

Ezetimibe inhibits the reabsorption of low-density lipoprotein and cholesterol through the intestine, thereby further enhancing the lipid-lowering effect with less side effects.

  In addition, PCSK9 inhibitors (alirocumab injection and evolocumab injection) launched in my country in recent years have shown strong cholesterol-lowering effects, bringing new hope to patients with hyperlipidemia.

Another example is bepedic acid, an ATP citrate lyase inhibitor that can reduce plasma LDL-C levels and major adverse cardiovascular events in patients with statin intolerance.

  It can be seen that when the therapeutic effect of statin drugs alone is not significant, non-statin drugs (especially PCSK9 inhibitors and ezetimibe) can be combined to help reduce LDL-C and promote the regression and stabilization of plaques.

  The string of “improving lifestyle” cannot be loosened

  The study concluded that it is "unclear" whether lifestyle intervention can reduce or stabilize coronary plaques.

So some people wonder whether we no longer need to insist on healthy eating and exercise. In fact, this is not the case. Even if we actively improve our living habits and cannot reverse plaque, it is still beneficial. At least it can help us prevent and manage atherosclerotic diseases. risk factors.

  For patients with carotid plaques who are asymptomatic and have no risk factors, if they can adhere to a reasonable diet, appropriate exercise, smoking cessation, alcohol restriction, and weight control for a long time, ensure that the low-density lipoprotein cholesterol (LDL-c) is < 2.6mmol/L. , there is no need to take lipid-lowering drugs.

  Text/Wang Fang (Beijing Hospital)