Submitted by Dr T on December 10, 2010 – 10:15am
What a good question! Take a look here for a description of the way the various heart medications work:
Of all the medications on your list only statins have been advertized as “reversers”. Don’t you believe it!
In order for an atherosclerotic plaque (blockage) to become obstructive to blood flow, it is generally assumed that it has to involve >70% of the circumference of an artery. Successful treatment then is to reduce this obstruction by a minimum of 20%, since at 50% the obstruction is no longer flow limiting (not taking into account increased needs with exertion).
In a 2009 study, two statin drugs were compared for their ability to reduce the thickness of a plague (another word for blockage) with Niacin (one of the drugs) winning with a 1.5% reduction after a year.
Using a reduction of 1.5% over a 14 months treatment period would result in >15 years of intense treatment with a drug (Niacin, vitamin B3) that is often poorly tolerated at high dosages (Flushing, itching, liver abnormalities).
Symptomatic patients or patients with tight lesions are at immediate risk, and don’t have time to wait for 14 months, let alone 15 years for reversal of their atherosclerosis. Studies like this point out the limitations of this type of treatment. However, they are quite useful as a treatment modality in patients with non-critical disease, or as adjunct therapy following an intervention such as PCI or CABG to prevent progression of disease elsewhere.
This doesn’t mean there is noting you can do. Quite to the contrary: if you live a healthy life style with all that it involves (diet, exercise, weight control, no smoking) you can prevent or stabilize coronary artery disease. Medications and procedures such as stents or coronary artery bypass surgery treat the complications of CAD not the atherosclerosis that causes it.
A more realistic statement would be that a combination of appropriate drug treatment, coupled with life style modifications will stop the progression of atherosclerosis.
Hope this helps,