8.3: Treatment

Treating atherosclerosis is like trying to keep the plumbing clear. The goal is to see that enough oxygenated blood is delivered through the narrowed arteries, and that clots don’t form inappropriately and block an artery.

Blood flow can be improved by widening the narrowed portion of an artery by physically removing or flattening the plaques,** or using drugs that dilate arteries. Sometimes, a section of a healthy blood vessel elsewhere in the body is used to bypass a narrowed section of a coronary artery (a coronary bypass). In a quintuple bypass (as had TV hosts Larry King at age 53 and David Letterman at age 52), five sections are bypassed.

Also, drugs can be used to lower the heart’s need for oxygen, e.g., drugs called beta- blockers can be used to slow the heartbeat, reducing the heart’s need for oxygen.††

Widening or bypass procedures often have to be repeated. Also keep in mind that not all arteries are as accessible as coronary arteries. There’s a risk of permanent brain damage in trying to surgically reach a narrowed artery (or an outpouching of an artery) in the brain.

Drugs that reduce the formation of blood clots (e.g., aspirin) are often prescribed to patients with atherosclerosis. When a clot blocks a blood vessel, a clot-dissolving drug (e.g., Activase) is often injected into the bloodstream to dissolve the clot as fast as possible.

It seems that intensive treatment to lower LDL in the blood can halt or even reverse the progression of atherosclerosis in some people. However, the first symptom of atherosclerosis is all too often a heart attack or stroke, and the person must, of course, survive long enough to be treated; many die before getting help or shortly thereafter. In one of every four fatal heart attacks, the heart attack was the first symptom.

Treatments of diseases resulting from atherosclerosis make up a major part of our health care costs and come with their own risks and side effects. This—and quality-of-life issues—is why prevention is so important.

^{**In what’s called angioplasty, a thin tube is threaded into the narrowed portion of the artery, and then the tube’s balloon is inflated to flatten the plaque. Then, a wire-mesh tube (a stent) can be placed there to help keep the artery open.
††Beta-blockers may have been used by some athletes in the 1988 Olympic archery competition to slow the heartbeat for another reason—to minimize disturbing the aim of the arrow by the heartbeat.}