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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Cardiology

Medical Management and Lifestyle Foundation

At a Glance

Atherosclerosis is managed by lowering LDL cholesterol, controlling blood pressure and glucose, using antiplatelet medicine only when its benefits outweigh bleeding risk, and adopting a heart-healthy lifestyle with exercise, nutritious food, and tobacco cessation.

Managing atherosclerosis is a lifelong commitment that combines heart-healthy habits with medications designed to stabilize existing plaque and prevent new buildup. While lifestyle changes are the foundation of care, most people with established disease or high risk require medications to achieve the significant risk reduction shown in clinical trials [1][2].

Cholesterol Management

Lowering LDL-C (the “bad” cholesterol) is a primary goal because it directly reduces the risk of heart attack and stroke. Specific goals depend on whether you are doing primary or secondary prevention and which guidelines your clinician follows (US or European). For very high-risk secondary prevention, targets are often below 70 mg/dL or below 55 mg/dL, whereas other categories have different thresholds [3][4].

Statin Therapy

Statins are the first-line treatment for atherosclerosis [5]. They work by slowing the liver’s production of cholesterol and help “calm” inflammation within the artery walls, making plaques more stable and less likely to rupture [6][5].

  • Intensity: High-intensity statins (like Atorvastatin 40–80 mg or Rosuvastatin 20–40 mg) aim to lower LDL-C by at least 50% [1].
  • Side Effects: While most people tolerate statins well, some experience muscle aches or weakness (statin-associated muscle symptoms). These symptoms can be unilateral or bilateral, delayed, or even unrelated to the statin [5]. If this happens, your doctor may adjust the dose, review interacting drugs, or use a “non-statin” alternative [7]. Do not stop taking your medication without guidance.
  • Diabetes Risk: Statins carry a small risk of modestly increasing blood glucose, but the cardiovascular benefits of indicated statin therapy overwhelmingly outweigh this small risk. Glucose monitoring is based on your baseline risk.

Non-Statin Options

If statins alone do not lower your LDL-C enough or are not tolerated, other medications can be added [3][4]:

  • Ezetimibe: A daily pill that prevents cholesterol absorption in the gut [8].
  • PCSK9 Inhibitors: Injectable medications (like Evolocumab or Alirocumab) that can lower LDL-C by an additional 60% [9].
  • Bempedoic Acid: An oral option often used for people who cannot tolerate statins. It requires monitoring for uric acid levels, as it can increase the risk of gout [10][11].

Antiplatelet Therapy

Platelets are the blood cells that form clots. Antiplatelet medications help keep blood flowing smoothly, but they increase the risk of bleeding. The choice requires an individualized bleeding and ischemic review.

  • Secondary Prevention (Clinical ASCVD): If you have already had a heart attack, stroke, symptomatic PAD, or a revascularization procedure (established clinical disease), daily antiplatelet medicine like aspirin or clopidogrel is standard to prevent future events [12][13].
  • Primary Prevention and Subclinical Plaque: Finding incidental plaque on a calcium scan or ultrasound (subclinical disease) does not automatically mean you should take antiplatelet therapy. Routine aspirin is not recommended for most adults for primary prevention, as the risk of internal bleeding often outweighs the heart benefits [12][14]. Never start either drug without an individualized clinician decision.
  • Dual Antiplatelet Therapy (DAPT): After a stent procedure or a heart attack, you may be prescribed two antiplatelet drugs (like aspirin plus clopidogrel) for a designated period to prevent the stent from clotting [15][16].

Blood Pressure and Glucose Control

  • Blood Pressure: High pressure “pounds” the artery walls, worsening atherosclerosis. For many high-risk patients, the goal is to keep blood pressure below 130/80 mmHg [17].
  • Blood Glucose: For patients with type 2 diabetes and ASCVD, medications like SGLT2 inhibitors or GLP-1 receptor agonists are often preferred because they provide heart and kidney protection beyond just lowering blood sugar [18][19].

The Lifestyle Foundation

Medication works best when supported by a heart-healthy lifestyle [2]:

  1. Diet: Focus on fruits, vegetables, legumes, nuts, fatty fish, and plant proteins. Limit saturated fats and highly processed foods [20][21].
  2. Activity: Aim for at least 150 minutes of moderate aerobic activity per week (like brisk walking). If you have exertional chest pain or severe claudication, obtain a safe exercise plan from your clinician [21][22].
  3. Tobacco Cessation: Smoking is a major driver of arterial damage. Quitting is the single most impactful lifestyle change you can make [23].
  4. Weight Management: Reducing excess body fat can help lower blood pressure and improve cholesterol and glucose levels [21].

Common questions in this guide

Which medicines are commonly used to manage atherosclerosis?
Statins are usually the first-line medicine because they lower LDL cholesterol and help make plaque less likely to rupture. If LDL remains above the person’s goal or statins are not tolerated, clinicians may add or substitute ezetimibe, a PCSK9 inhibitor, or bempedoic acid. Other medicines may be used for blood pressure, diabetes, or clot prevention when appropriate.
What LDL cholesterol goal should I have with atherosclerosis?
Your LDL cholesterol goal depends on whether treatment is preventing a first cardiovascular event or preventing another event after established disease, as well as which guideline your clinician uses. For very-high-risk secondary prevention, goals are often below 70 mg/dL or below 55 mg/dL. Your clinician should set the target and decide how often to recheck it.
How should I respond to muscle aches while taking a statin?
Tell your clinician about new muscle aches or weakness rather than stopping the statin on your own. They may check for other causes and medicine interactions, adjust the dose, try a different statin, or use a non-statin option. Most people tolerate statins, and treatment decisions should balance symptoms with cardiovascular benefit.
Do I need aspirin if a scan finds plaque in my arteries?
Not necessarily. Plaque found on a calcium scan or ultrasound does not automatically call for aspirin, and routine aspirin is not recommended for most adults trying to prevent a first heart attack or stroke because internal bleeding can outweigh the benefit. Aspirin or clopidogrel is commonly used after established disease, but the decision should be individualized; two antiplatelet drugs may be prescribed for a period after a stent or heart attack.
What lifestyle changes can help manage atherosclerosis?
Choose a diet rich in vegetables, fruits, legumes, nuts, fatty fish, and plant proteins, while limiting saturated fat and highly processed foods. Aim for at least 150 minutes of moderate aerobic activity each week, stop tobacco use, and work toward a healthy weight. If exercise causes chest pain or severe leg pain from poor circulation, ask your clinician for a safe plan.
Can diabetes medicines help protect my heart if I have atherosclerosis?
For people with type 2 diabetes and established atherosclerotic cardiovascular disease, SGLT2 inhibitors and GLP-1 receptor agonists may provide heart and kidney benefits beyond lowering blood sugar. They may be considered even when glucose is well controlled, but the choice depends on your health history and clinician’s advice.
What blood pressure target is typical for someone at high risk?
Many high-risk patients are advised to aim for a blood pressure below 130/80 mmHg, but the right goal can vary with age, other conditions, medicines, and tolerance. Ask whether home monitoring would help and how often to share readings with your care team.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my specific LDL-C target, and how often will we test my levels to see if we've reached it?
  2. 2.If I develop muscle aches while taking a statin, what are the next steps for adjusting my dose or trying a different medication?
  3. 3.Based on my current risk, is daily aspirin recommended for me, or do the bleeding risks outweigh the benefits?
  4. 4.Since I have atherosclerosis, should we consider adding a GLP-1 or SGLT2 inhibitor to my treatment plan even if my blood sugar is well-controlled?
  5. 5.What is the specific blood pressure goal for me, and should I be monitoring it at home?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (23)
  1. 1

    Trends of lipid-lowering drug utilization, treatment intensity and LDL-C target attainment in adults with diabetes and non-dialysis chronic kidney disease in Hong Kong.

    Huang Y, Yang A, Shi M, et al.

    The Lancet regional health. Western Pacific 2025; (63()):101696 doi:10.1016/j.lanwpc.2025.101696.

    PMID: 41080409
  2. 2

    Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries.

    Kotseva K, De Backer G, De Bacquer D, et al.

    European journal of preventive cardiology 2021; (28(4)):370-379 doi:10.1177/2047487320908698.

    PMID: 33966079
  3. 3

    Inclisiran: A New Strategy for LDL-C Lowering and Prevention of Atherosclerotic Cardiovascular Disease.

    Albosta MS, Grant JK, Taub P, et al.

    Vascular health and risk management 2023; (19()):421-431 doi:10.2147/VHRM.S338424.

    PMID: 37434791
  4. 4

    From clinical inertia to therapeutic optimization in patients with atherosclerotic cardiovascular disease: A Monte Carlo simulation within the ITACARE-P registry.

    Faggiano A, Maloberti A, Ambrosetti M, et al.

    Journal of clinical lipidology 2025; doi:10.1016/j.jacl.2025.11.010.

    PMID: 41391973
  5. 5

    A Brief Drug Class Review: Considerations for Statin Use, Toxicity, and Drug Interactions.

    Wooten JM

    Southern medical journal 2018; (111(1)):39-44 doi:10.14423/SMJ.0000000000000752.

    PMID: 29298368
  6. 6

    Atherosclerosis.

    Libby P, Buring JE, Badimon L, et al.

    Nature reviews. Disease primers 2019; (5(1)):56 doi:10.1038/s41572-019-0106-z.

    PMID: 31420554
  7. 7

    Statin-Associated Myopathy: Emphasis on Mechanisms and Targeted Therapy.

    Vinci P, Panizon E, Tosoni LM, et al.

    International journal of molecular sciences 2021; (22(21)) doi:10.3390/ijms222111687.

    PMID: 34769118
  8. 8

    Bempedoic acid vs ezetimibe added to statin therapy: Cardiovascular outcomes in the real-world-The BEYOND-REAL Study.

    White RT, Ansong BO, Cowart K

    Journal of clinical lipidology 2026; (20(5)):1023-1029 doi:10.1016/j.jacl.2026.02.014.

    PMID: 41820083
  9. 9

    Bempedoic Acid: Lipid Lowering for Cardiovascular Disease Prevention.

    Albosta M, Grant JK, Michos ED

    Heart international 2023; (17(2)):27-34 doi:10.17925/HI.2023.17.2.1.

    PMID: 38419721
  10. 10

    Association of Bempedoic Acid Administration With Atherogenic Lipid Levels in Phase 3 Randomized Clinical Trials of Patients With Hypercholesterolemia.

    Banach M, Duell PB, Gotto AM, et al.

    JAMA cardiology 2020; (5(10)):1124-1135 doi:10.1001/jamacardio.2020.2314.

    PMID: 32609313
  11. 11

    Reshaping Dyslipidaemia Treatment with Bempedoic Acid-A Narrative Review.

    Strikic D, Begic Z, Radman I, et al.

    Biomedicines 2025; (13(6)) doi:10.3390/biomedicines13061460.

    PMID: 40564178
  12. 12

    Aspirin for Primary Prevention in Patients With Elevated Coronary Artery Calcium Score: A Systematic Review of Current Evidences.

    Doshi A, Gandhi H, Patel KN, et al.

    The American journal of cardiology 2024; (220()):9-15 doi:10.1016/j.amjcard.2024.03.021.

    PMID: 38548012
  13. 13

    Do we have a unified consensus on antithrombotic management of PAD?

    Poredos P, Antignani PL, Blinc A, et al.

    International angiology : a journal of the International Union of Angiology 2021; (40(3)):229-239 doi:10.23736/S0392-9590.21.04597-1.

    PMID: 33739074
  14. 14

    Potential Impact of the 2019 ACC/AHA Guidelines on the Primary Prevention of Cardiovascular Disease Recommendations on the Inappropriate Routine Use of Aspirin and Aspirin Use Without a Recommended Indication for Primary Prevention of Cardiovascular Disease in Cardiology Practices: Insights From the NCDR PINNACLE Registry.

    Hira RS, Gosch KL, Kazi DS, et al.

    Circulation. Cardiovascular quality and outcomes 2022; (15(3)):e007979 doi:10.1161/CIRCOUTCOMES.121.007979.

    PMID: 35098732
  15. 15

    The Balancing Act: A Rational Approach to Postintervention Dual Antiplatelet Therapy.

    Mehta N, Samat D

    The Journal of the Association of Physicians of India 2024; (72(11)):11-13 doi:10.59556/japi.72.0668.

    PMID: 39563109
  16. 16

    Oral Antiplatelet Therapy After Acute Coronary Syndrome: A Review.

    Kamran H, Jneid H, Kayani WT, et al.

    JAMA 2021; (325(15)):1545-1555 doi:10.1001/jama.2021.0716.

    PMID: 33877270
  17. 17

    Hypertension in Chronic Kidney Disease (CKD): Diagnosis, Classification, and Therapeutic Targets.

    Georgianos PI, Agarwal R

    American journal of hypertension 2021; (34(4)):318-326 doi:10.1093/ajh/hpaa209.

    PMID: 33331853
  18. 18

    SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials.

    Zelniker TA, Wiviott SD, Raz I, et al.

    Lancet (London, England) 2019; (393(10166)):31-39 doi:10.1016/S0140-6736(18)32590-X.

    PMID: 30424892
  19. 19

    Glucose-lowering pharmacotherapies in Chinese adults with type 2 diabetes and cardiovascular disease or chronic kidney disease. An expert consensus reported by the Chinese Diabetes Society and the Chinese Society of Endocrinology.

    Hong T, Su Q, Li X, et al.

    Diabetes/metabolism research and reviews 2021; (37(4)):e3416 doi:10.1002/dmrr.3416.

    PMID: 33120435
  20. 20

    Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement.

    Belardo D, Michos ED, Blankstein R, et al.

    American journal of preventive cardiology 2022; (10()):100323 doi:10.1016/j.ajpc.2022.100323.

    PMID: 35284849
  21. 21

    Nutrition and physical activity recommendations from the United States and European cardiovascular guidelines: a comparative review.

    Ferraro RA, Fischer NM, Xun H, Michos ED

    Current opinion in cardiology 2020; (35(5)):508-516 doi:10.1097/HCO.0000000000000763.

    PMID: 32649350
  22. 22

    Aerobic or Resistance Exercise for maximum Cardiovascular Disease Protection? An Appraisal of the Current Level of Evidence.

    Dimitriadis N, Panagiotakos D

    Journal of preventive medicine and hygiene 2024; (65(3)):E323-E329 doi:10.15167/2421-4248/jpmh2024.65.3.3198.

    PMID: 39758774
  23. 23

    Drugs for Primary Prevention of Atherosclerotic Cardiovascular Disease: An Overview of Systematic Reviews.

    Karmali KN, Lloyd-Jones DM, Berendsen MA, et al.

    JAMA cardiology 2016; (1(3)):341-9 doi:10.1001/jamacardio.2016.0218.

    PMID: 27438118

This page explains medication and lifestyle strategies for atherosclerosis for informational purposes only and does not constitute medical advice. Ask your clinician before starting, stopping, or changing treatment.

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