Atherosclerosis drug therapy

When drug therapy fails or if extensive coronary atherosclerosis is present, PCI is often performed to restore coronary blood flow, relieve symptoms, and prevent major adverse cardiac events. Patients with one or more critical coronary stenoses (i.e., greater than 70% occlusion of the coronary lumen) detected during coronary angiography may be candidates for PCI. Several catheter-based interventions maybe used during PCI, including ... 

Feher MD, Webb JC, Patel DD, Lant AF, Mayne PD, Knight BL, et al. Cholesterol-lowering drug therapy in a patient with receptor-negative homozygous familial hypercholesterolaemia. Atherosclerosis 1993 103 171-180. 

Enconragingly, there is increasing, robust scientific evidence that atherosclerosis can be arrested and even decreased by pharmacologic approaches. However, the evaln-ation of drug therapy for this condition is complicated by the fact that the regulation of cholesterol metabolism alone does not necessarily have a beneficial effect on atherosclerosis. 

The decision to use drug therapy for hyperlipidemia is based on the specific metabolic defect and its potential for causing atherosclerosis or pancreatitis. Suggested regimens for the principal lipoprotein disorders are presented in Table 35-2. 

Hyperlipidemia can lead to atherosclerosis and subsequent cardiovascular incidents such as thrombosis and infarction. This condition is often treated by a combination of drug therapy and diet and life-style modifications. Pharmacologic interventions are typically targeted toward decreasing the synthesis of harmful (atherogenic) plasma components, including certain lipoproteins (IDL, LDL, VLDL) that are associated with atherosclerotic plaque formation. 

Drug treatment to lower plasma lipoproteins and/or cholesterol is primarily aimed at reducing the risk of atherosclerosis and subsequent coronary artery disease that exists in patients with elevated circulating lipids. Drug therapy is considered as an option only if non-pharmacologic interventions (altered diet and exercise) have failed to lower plasma lipids. 

A decrease in serum cholesterol levels results in a decrease not only in the lipid content but also in the size of experimentally induced atherosclerotic lesions. Evidence of this association in man has been demonstrated by coronary angiography. " Human femoral atherosclerosis regressed in response to diet and/or drug therapy (clofibrate, NA, or clofibrate in combination with neomycin). "> The degree of retardation of atherosclerosis was directly correlated with the decrease in serum cholesterol levels. " Regression in patients with Type IV hyperlipoproteinemia was also associated with the decrease in serum triglyceride levels however, no such correlation was found in another study. ... 

Tan TY, Lu CH, Chuang HY, Lin TK, Liou CW, Chang WN, Chuang YC. Long-term antiepileptic drug therapy contributes to the acceleration of atherosclerosis. Epilepsia 2009 50(6) 1579-86. 

In view of the detailed published information available on the presence, functional characteristics, and localization of scavenger receptor populations in atherosclerotic lesions (cf. above) as well as the known structural similarity between modified LDL and LCM (cf. Sections 12.1, 14.2.2-14.2.2(ii)), LCM-directed drug delivery to atherosclerotic lesions may offer a means for targeted drug-delivery therapy of atherosclerosis. 

Probucol is a lipid-lowering agent, but the results are not consistent with respect to LDL cholesterol. It lowers HDL cholesterol hence it is not the first drug of choice in therapy. The ability of probucol to correct atherosclerosis has been attributed to its antioxidant properties.77 The usual oral dose is 500 mg twice daily and is administered after food. Many experts use it as adjuvant therapy in familial hypercholesterolemia. The drug is well tolerated but causes GI side effects such as nausea and flatulence, headache, and dizziness. Patients taking probucol must be on a low-fat diet. Probucol should not be used in patients with recent myocardial infarction, and it should not be given to children or pregnant women. 

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