Untreated, atherosclerotic cardiovascular disease can have serious consequences.
You might be used to hearing the term “heart disease,” but a more accurate term might be “heart diseases.” That’s because heart disease is actually a category of diseases with many different types. One of those types is atherosclerotic cardiovascular disease, or ASCVD.
What Is ASCVD?
ASCVD gets its name because it stems from atherosclerosis. This refers to plaque buildup in the artery walls that narrows the arteries. Plaque buildup typically occurs when someone has high cholesterol that goes untreated.
“When we think about atherosclerotic heart disease, we're specifically looking at the blood vessels that are supplying blood to the heart muscle,” says Lawrence Phillips, MD, cardiologist at NYU Langone Health. “The reason that's important is because when you have narrowing in those blood vessels, you're at an increased risk of having symptoms like chest pain or shortness of breath.” Furthermore, it increases the risk of a heart attack.
The main treatment for high cholesterol—besides lifestyle changes—is statin therapy. Statins are medications that decrease the amount of cholesterol produced by the liver. They also help the liver remove more cholesterol. As a result, they reduce LDL (“bad”) cholesterol to improve cardiovascular health.
“By taking a statin, we know that it decreases the risk of progression or worsening of atherosclerotic heart disease and decreases your risk of having a heart attack,” says Dr. Phillips.
But sometimes, you may need a second-line statin. This means the first statin you try wasn’t the right fit, so you try an alternate option. Luckily, there are several types of statins that all work in slightly different ways. If one doesn’t help enough (or causes unwanted side effects), you have other options. Learn more about what second-line statins are here.
If your first statin isn’t the best fit, your second-line statin may help slow the progression of ASCVD. Finding the best statin for you and taking it as prescribed could help you reach your target cholesterol levels. This in turn can prevent ASCVD complications like heart attack and stroke.
“When a patient is not able to tolerate one medication and expresses frustration, the first thing to do is to reassure them that this is very common,” says Dr. Phillips. “We have many different options that we can use in medications, both within the statin class and others. [In] the great majority of patients, if we work together, we can reach our target.”
Lawrence Phillips, MD, is a cardiologist at NYU Langone Health. Dr. Phillips is the assistant professor of the Department of Medicine at NYU Grossman School of Medicine, the assistant clinical director for strategic affairs at Leon H. Charney Division of Cardiology, the director of the Nuclear Cardiology Laboratory, the medical director for Outpatient Clinical Cardiology, and the associate director of the Cardiovascular Disease Fellowship Program.
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So atherosclerosis is a general term
to look at
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deposits of plaque in blood vessels throughout the body.
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Most commonly, we talk about
atherosclerotic heart disease,
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so narrowing of the blood vessels
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that are supplying blood to the heart.
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The risk of developing atherosclerotic heart disease
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is based on many factors such as obesity,
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smoking use, which increases it,
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their blood pressure which increases it,
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their family history, as well as the cholesterol,
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which we want to be aggressive in treating.
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The way to loser your risk of
atherosclerotic heart disease
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is first to know what your risk is.
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We want to know your medical history,
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your family medical history,
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as well as learning about your lifestyle
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and changes that can benefit you.
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In addition, you want to know your numbers.
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You want to learn your high blood pressure numbers,
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making sure that it's well controlled.
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You want to learn your cholesterol to see
if that needs to be modified.
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You want to know what your blood sugar is
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to see if you're at risk of diabetes.
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You want to make sure that your weight
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is at the appropriate level
and come up with a plan
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to modify all of these if needed.
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A statin is a class of medications which impact
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the liver's production of cholesterol.
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By taking a statin, we know that it decreases the risk
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of progression or worsening
of atherosclerotic heart disease.
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So if a patient's been prescribed a statin,
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and they're not reaching their targets,
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there are a couple things that we want to do.
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First thing is we want to make sure that
there are no barriers
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to them being successful with the medication.
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These barriers can include cost, side effects,
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or they can include a patient's inability
to be on medications.
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Second, if a patient is compliant with the medications,
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we want to see if there's a dose change that's needed.
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If a patient is placed on a statin,
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and they're not able to reach their target,
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we'll often change them to another more potent
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statin medication first.
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We can get our numbers to goal,
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as well as stabilizing the blood vessels
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and decreasing the chance of worsening
of the atherosclerosis.
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Another time where we'll change a patient
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from one statin to another is when they're having
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side effects such as muscle aches.
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When a patient is not able to tolerate one medication,
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and expresses frustration,
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the first thing to do is to reassure them
that this is very common,
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and that we have many different options
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that we can use
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in medications both within the statin class and others,
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but in the great majority of patients,
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if we work together, we can reach our target.
- About heart disease. Atlanta, GA: Centers for Disease Control and Prevention, 2020. (Accessed on September 21, 2020)
- Overview of risk factors for development of atherosclerosis and early cardiovascular disease in childhood. Waltham, MA: UpToDate, 2020. (Accessed on September 21, 2020)
- Pathogenesis of atherosclerosis. Waltham, MA: UpToDate, 2020. (Accessed on September 21, 2020)