How Statins Can Reduce Plaque Buildup

Have you ever taken apart the drainpipe beneath your sink and looked inside? If so, you know things can get pretty gunked up in there.

It’s the same story with arteries carrying blood through your body. Your internal pipes can get clogged with a buildup of fatty plaque, which can increase your risk of a heart attack or stroke over time.

Statins are medications that can reduce plaque formation on artery walls by lowering cholesterol levels — particularly “bad” cholesterol levels. We asked cardiologist Tamanna Singh, MD, to explain the process.

How statins affect plaque buildup

So, how do statins work their magic to limit plaque formation and reduce potential health concerns? Let’s break it down.

Reduces cholesterol production

Your body needs a certain amount of cholesterol for important functions, like producing hormones and bile. Most of the cholesterol in your system is made by your liver to meet those needs.

But the key is balance. Too much cholesterol in your bloodstream — particularly when it’s harmful low-density lipoprotein (LDL) cholesterol — can contribute to serious health concerns.

Statins tamp down cholesterol production by blocking the activity of a particular enzyme.

“The HMG-CoA reductase enzyme plays a very important role when it comes to cholesterol production in the liver,” explains Dr. Singh. “So, if we block that role, we can really reduce cholesterol production to help limit risk.”

Lowers ‘bad’ cholesterol in your blood

Overall, making less cholesterol is a good thing, but remember: Your body needs some of it. So, as your liver makes less thanks to statins, it has to get resourceful to make sure it has enough cholesterol.

To do this, your liver puts catchers on its surface called receptors. These receptors grab LDL cholesterol floating through your bloodstream and pull it into the liver for future use or to expel it from the body.

LDL cholesterol is what causes plaque to build up on your blood vessel walls (atherosclerosis). These fatty deposits can narrow and harden your arteries, which can reduce or eventually even block blood flow.

“Receptors essentially clean up your blood and eliminate LDL cholesterol that could cause problems,” says Dr. Singh.

Changes plaque structure

Statins don’t just reduce cholesterol to limit your health risk. Dr. Singh emphasizes that these medications also affect the structure and stability of plaque, which makes your arteries safer. It does this by:

• Reducing inflammation: Statins help reduce inflammation that makes plaques unstable and prone to rupture, which can lead to heart attack or stroke. Calming this inflammation makes plaque less dangerous.
• Strengthening plaque structure: Plaque is made up of fatty deposits and other materials. Statins work to strengthen the fibrous cap that surrounds plaque, which makes it less likely to break open and create a clot that can block an artery.
• Decreasing plaque size: Statins can reduce the amount of cholesterol and fat inside plaques, which may shrink them over time. This can improve blood flow and lower the chance of blockages.

How effective is statin therapy at reducing plaque?

Statins are extremely effective at quickly lowering LDL cholesterol and reducing plaque. (That kind of explains why doctors in the U.S. wrote 818 million prescriptions for the medication during a recent year!)

Some statins can reduce LDL cholesterol by more than half. That can help you hit what’s considered a healthy cholesterol level.

In general, it’s recommended that adults keep their LDL level below 100 milligrams per deciliter (mg/dL). But if you’re at risk of plaque buildup, the LDL target goal drops to 70 mg/dL or lower.

“If you bring your LDL level below 70, you could potentially see a plaque regression of up to 24%,” says Dr. Singh. “But it starts with being very aggressive about LDL reduction.”

LDL levels typically drop within two to three months after starting treatment, she adds.

Best statins for plaque reduction

The two most potent statins on the market are atorvastatin (Lipitor®) and rosuvastatin (Crestor®), says Dr. Singh. It’s not a coincidence that those two products also rank as the most prescribed statins to lower cholesterol and reduce plaque.

“Moderate to high-potency statins give you the biggest bang for your buck,” she says. “The medications are impactful and well-tolerated and bring relatively quick results.”

Overall, the U.S. Food and Drug Administration (FDA) has approved eight statin medications in the United States. Plus, three more FDA-approved products combine a statin with another medication in a single pill.

These medications vary in potency based on their chemical structure, which affects how you’re your body responds to them to limit cholesterol production. But each approved medication has its place when it comes to treating high cholesterol.

“Some people simply respond better to one statin than another,” notes Dr. Singh.

Alternate ways to prevent plaque buildup

Are statins increasingly used to lower cholesterol and reduce plaque? Without a doubt. But they’re not the only way to improve your cholesterol numbers.

Adjusting your diet to a more heart-healthy eating plan (like the Mediterranean diet) can drive down your LDL numbers. Ditto for starting a regular exercise program, which can lower LDL cholesterol and boost your “good” high-density lipoprotein (HDL) cholesterol.

“I try to empower people to control the controllables — what you put in your mouth and how you move your body,” says Dr. Singh. “Making healthy lifestyle changes can certainly reduce your risk.”

New medications are also being studied with promising results. If approved for use in the future, they could be a major benefit for people who don’t respond well to statins.

Final thoughts

If you have high cholesterol, bringing those numbers down is important for your long-term health. Maybe that means talking to your healthcare provider about taking a statin. Or maybe it involves trying another approach to minimize dangerous plaque buildup.

What’s important, though, is that you do something.

“If your goal is to live a healthy, mobile, high-functioning quality of life for as long as possible, managing your cholesterol is one way to help make that happen,” says Dr. Singh. “Now is always the best time to take a preventative step.”