Arteriosclerosis (Hardening of the Arteries): Drug Therapy

Therapeutic target

Prevention of cardiovascular (heart disease) complications from the spread of atherosclerosis (arteriosclerosis, hardening of the arteries).

Therapy recommendations

  • First-line drugs: lipid-lowering agents/drugs for elevated lipid levels (drug groups depending on the form of hyperlipidemia/dyslipidemia)
    • HMG-CoA reductase inhibitors (statins) should also according to current US guidelines:
      • In all individuals with LDL > 190 mg/dl.
      • In patients with manifest atherosclerotic cardiovascular disease; independent of LDL cholesterol.
      • Individuals over 40 years of age with a 10-year risk of cardiovascular disease > 7.5 %; independent of LDL cholesterol
      • Individuals with type 2 diabetes between 40 and 75 years of age to be used; independent of LDL cholesterol.
    • The US guidelines for reducing the risk of atherosclerosis, which have expanded the indications for statin therapy while waiving cutoff values, are supported by recent studies.
  • Treatment of comorbidities (concomitant diseases).
  • See also under “Further therapy“.

Further notes

  • In patients 75 years of age and older, lipid lowering was as effective in reducing cardiovascular events as in patients younger than 75 years. These findings should strengthen guideline recommendations for the use of lipid-lowering therapies, including statin-free treatment, in elderly patients.

Effect of different lipid-lowering agents on respective lipid fractions:

Active ingredient groups/active ingredients LDL HDL TG
Fibrate – 20 % ↓ – 20 % ↑ – 40 % ↓
Replacement resins – 20 % ↓ – 8 % ↑ –
Ezetimibe (with statin) – 25 % ↓ No data No data
Nicotinic acid derivative – 30 % ↓ – 20 % ↑ – 40 % ↓
Statins – 40 %↓ – 10 % ↑ – 20 % ↓
PCSK9 inhibitors (alirocumab* , evolocumab). 50-60 % ↓ 50

More hints

  • According to European guidelines, if the risk of a cardiovascular event in the next few years is 10% to 20%, treatment of dyslipidemia, with the goals of lowering LDL cholesterol and increasing HDL cholesterol, is warranted.
  • * Removed from the market in Germany for patent reasons according to the notification of July 18, 2019.
  • Ezetimibe: combination with statins advisable (additive effect); eg, combination of 20 mg atorvastatin and 10 mg ezetimibe brings an additional LDL reduction of 31%.