The first goal for treatment of atherosclerosis is to restore as much blood flow as possible through the affected portion of the vascular system and to reduce the risk of a plaque rupture, which can result in a heart attack or stroke. This can sometimes be achieved by reducing risk factors, getting regular exercise and/or taking medications such as:

• Antiplatelets (e.g., aspirin) inhibit the formation of blood clots by decreasing the ability of platelets (the body’s natural blood-clotters) to bind together. In the case of atherosclerosis, antiplatelets prevent a damaged vessel from becoming blocked due to excessive concentration of platelets.
  
  
• Beta blockers reduce the workload of the heart by blocking the effect of adrenaline and the sympathetic nervous system on the heart.
  
  
• Nitrates work directly on blood vessels supplying the heart muscle, causing them to relax and allowing oxygen-rich blood to reach the heart.
  
  
• Cholesterol-reducing drugs (e.g., statins) lower the patient’s level of fats (lipids) in the blood, such as cholesterol and triglycerides. High LDL levels are associated with increased risk of heart attack and stroke.
  
  
• ACE inhibitors block the production of a substance that causes blood vessels to tighten, allowing more oxygen-rich blood to flow into the heart.
  
  
• Vitamins may also be helpful, especially folic acid, which counteracts the dangerous effects of certain amino acids. Folic acid should always be taken in conjunction with vitamin B12 because folic acid can mask a vitamin B12 deficiency. However, it should only be administered as directed by a physician.

If medication is not helpful, more invasive treatments may be necessary to restore blood flow. For example, the physician may choose to perform a catheter-based procedure. During this procedure, a thin tube (catheter) is inserted through a blood vessel in the body (usually in the groin) and fed all the way to the heart. Once in place, one or more of the following procedures may be done:

• Balloon angioplasty. A balloon-tipped catheter presses plaque back against the artery walls, increasing the amount of room through which blood can pass through the vessel.
  
  
• Stenting. A wire mesh metal tube called a stent can be inserted into the area of a damaged artery. The stent acts as a scaffold, stretching and supporting the artery walls, and permitting blood to flow freely through the previously blocked vessel. Newer stents are coated with special drugs that help prevent restenosis, or reclosure of the artery after the procedure.
  
  
• Atherectomy. A procedure that uses a specialized catheter that removes plaque by cutting or grinding it away. Depending on the technique used, the residue is pulverized and 1) allowed to flow harmlessly through the bloodstream; 2) removed as the catheter is withdrawn; or 3) vacuumed through the catheter and out of the body during the procedure.

With severe disease, or atherosclerosis that occurs in multiple veins or coronary arteries, a coronary artery bypass graft (CABG) may be recommended. During this form of open-heart surgery, a heart surgeon uses vein grafts to bypass the blocked portions of the coronary arteries. In the carotid arteries, severe disease may be treated with a procedure called a carotid endarterectomy. During this procedure, the surgeon exposes the arteries in the neck, then strips away the inner lining of the artery, including the plaque deposit.