What Drug Removes Plaque from Arteries? A Pharmacological Review

October 7, 2025 •

4 min read

In a study of over 25,000 middle-aged adults with no known heart disease, over 42% were found to have atherosclerosis (plaque buildup) [1.8.4]. So, what drug removes plaque from arteries and how can this condition be managed?

Quick Summary

An overview of medications that address arterial plaque. It details how drugs like statins and PCSK9 inhibitors work to lower cholesterol, stabilize plaque, and can lead to regression of atherosclerosis.

Key Points

No Magic Bullet: No single drug 'dissolves' plaque, but medications like statins and PCSK9 inhibitors can significantly reduce and even reverse its buildup [1.2.3, 1.3.4].
Statins as First-Line Therapy: Statins lower LDL cholesterol and have anti-inflammatory effects that stabilize dangerous soft plaque, making it less likely to rupture [1.3.1, 1.3.5].
PCSK9 Inhibitors for Major Reduction: These powerful injectable drugs can dramatically lower LDL and have been shown to cause significant plaque regression [1.4.1, 1.4.5].
Combination Therapy is Key: Combining drugs like a statin with ezetimibe often leads to better plaque reduction than a statin alone [1.5.2].
Lifestyle is Crucial: Medications are most effective when paired with a heart-healthy diet, regular exercise, and smoking cessation [1.7.1, 1.7.3].
Plaque Stabilization is a Primary Goal: A major benefit of these drugs is transforming unstable, rupture-prone plaque into a more stable, calcified form [1.3.1, 1.3.2].
Consult a Professional: Treatment for atherosclerosis is highly individualized and must be managed by a healthcare provider [1.2.1].

Understanding Atherosclerosis and Arterial Plaque

Atherosclerosis is the buildup of a waxy substance called plaque inside the arteries [1.7.1]. This plaque is composed of fat, cholesterol, calcium, and other substances found in the blood [1.7.1]. Over time, this buildup can harden and narrow the arteries, restricting blood flow. The most dangerous type of plaque is soft, non-calcified plaque, which is unstable and can rupture, leading to blood clots that cause heart attacks or strokes [1.3.1]. While no medication acts like a chemical drain cleaner to simply dissolve all plaque, several classes of drugs can effectively reduce, stabilize, and even cause a regression (shrinking) of this plaque buildup [1.2.3, 1.3.4].

The Primary Medications for Plaque Reduction

The main strategy for combating arterial plaque is to aggressively lower levels of low-density lipoprotein (LDL) cholesterol, often called "bad" cholesterol, which is a primary component of plaque [1.2.3, 1.3.3].

Statins

Statins are the first-line treatment for high cholesterol and are proven to combat plaque [1.2.2]. They work by blocking a key enzyme in the liver (HMG-CoA reductase) that is responsible for cholesterol production [1.3.5]. This lowers the amount of LDL cholesterol in the bloodstream, reducing the material available for plaque formation [1.3.3]. Beyond just lowering LDL, statins have crucial anti-inflammatory properties that help stabilize existing plaque [1.3.5]. They effectively "melt" the dangerous soft, fatty components, leaving behind a more stable, calcified scar that is less likely to rupture [1.3.1]. High-intensity statin therapy with drugs like atorvastatin (Lipitor) and rosuvastatin (Crestor) has been shown in clinical studies to cause a regression of plaque by up to 24% when LDL levels are lowered below 70 mg/dL [1.3.4].

PCSK9 Inhibitors

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a powerful class of injectable drugs used when statins are not enough or are not tolerated [1.2.2]. These monoclonal antibodies work by blocking the PCSK9 protein, which normally degrades LDL receptors on the liver. By inhibiting PCSK9, more receptors are available to actively clear LDL cholesterol from the blood, leading to dramatic reductions [1.2.2]. Clinical trials like GLAGOV and ARCHITECT have demonstrated that PCSK9 inhibitors, such as evolocumab (Repatha) and alirocumab (Praluent), lead to significant regression of coronary plaque volume and promote stabilization by reducing the necrotic core and increasing the fibrous, more stable parts of the plaque [1.4.1, 1.4.4, 1.4.5].

Other Cholesterol-Lowering Agents

Ezetimibe (Zetia): This medication works differently from statins by inhibiting the absorption of cholesterol in the small intestine [1.5.2]. It is often added to statin therapy to achieve further LDL reduction. Studies have shown that combining ezetimibe with a statin can lead to greater coronary plaque regression compared to statin therapy alone and can help increase the thickness of the fibrous cap, making plaque more stable [1.5.2].
Bempedoic Acid (Nexletol): This is a newer oral medication that lowers cholesterol by inhibiting an enzyme called ATP-citrate lyase in the liver [1.9.1]. It is a valuable option for patients who experience muscle-related side effects from statins [1.9.3]. While direct data on plaque regression is still emerging, its ability to significantly lower LDL cholesterol suggests it plays a beneficial role in reducing the progression of atherosclerosis [1.9.1, 1.9.2]. One study showed it reduced carotid atherosclerosis by 7% over 6 months when added to statin therapy [1.9.4].

Comparison of Plaque-Reducing Medications


Drug Class	Primary Mechanism	Effect on Plaque	Common Examples	Administration
Statins	Inhibits cholesterol production in the liver [1.3.5]	Reduces LDL, stabilizes plaque, promotes regression [1.3.1, 1.3.4]	Atorvastatin, Rosuvastatin [1.3.4]	Oral Pill
PCSK9 Inhibitors	Increases LDL receptors on the liver to clear LDL from blood [1.2.2]	Dramatically reduces LDL, promotes significant regression and stabilization [1.4.1, 1.4.5]	Evolocumab, Alirocumab [1.2.2]	Subcutaneous Injection
Ezetimibe	Inhibits cholesterol absorption in the intestine [1.5.2]	Further reduces LDL, contributes to plaque regression and stabilization [1.5.2]	Ezetimibe [1.5.1]	Oral Pill
Bempedoic Acid	Inhibits a different cholesterol synthesis pathway in the liver [1.9.1]	Reduces LDL, particularly for statin-intolerant patients [1.9.2]	Bempedoic Acid [1.9.3]	Oral Pill

The Indispensable Role of Lifestyle and Other Medications

Medication alone is not a complete solution. A comprehensive approach is necessary for managing atherosclerosis.

Supporting Medications

Antiplatelet Agents: Drugs like aspirin and clopidogrel do not remove plaque, but they are critical for preventing blood clots from forming if a plaque ruptures. This is essential for preventing heart attacks and strokes [1.2.4, 1.10.3].
Blood Pressure Medications: High blood pressure damages artery walls, accelerating plaque buildup [1.7.1]. Medications like ACE inhibitors and beta-blockers help control this damage [1.2.1]. Some studies suggest they may also have direct beneficial effects on the atherosclerotic process [1.11.2, 1.11.3].

Lifestyle Modifications

Lifestyle changes are fundamental and can help shrink and stabilize plaques [1.2.3, 1.7.3].

Diet: Adopting a heart-healthy diet, such as the Mediterranean diet, rich in fruits, vegetables, and olive oil while being low in saturated and trans fats, is crucial [1.7.4].
Exercise: Regular physical activity (aiming for at least 150 minutes of moderate-intensity exercise per week) helps lower bad cholesterol, raise good cholesterol, and improve overall arterial health [1.7.1, 1.7.4].
Quit Smoking: Smoking is a major cause of arterial damage and quitting is one of the most effective steps to halt the progression of the disease [1.7.1, 1.7.2].

Conclusion

While the idea of a single drug that removes all plaque from arteries remains in the realm of science fiction, modern pharmacology offers powerful tools to combat atherosclerosis. The cornerstone of treatment involves aggressively lowering LDL cholesterol with medications like statins and PCSK9 inhibitors, which have been proven to not only slow the disease but also cause plaque regression and stabilization. These are often supplemented by drugs like ezetimibe, bempedoic acid, and medications to control blood pressure and prevent clots. However, the success of any medical therapy is magnified when combined with foundational lifestyle changes, including a healthy diet, regular exercise, and smoking cessation. Any treatment plan must be developed and monitored in consultation with a healthcare professional.

Authoritative Link: Atherosclerosis - Johns Hopkins Medicine

Frequently Asked Questions

While it is not possible to make plaque disappear completely, medications combined with intensive lifestyle changes can cause plaques to shrink (regress) and stabilize, significantly reducing risk [1.2.3, 1.3.4].

Statins begin lowering LDL cholesterol within weeks. Effects on plaque stabilization and regression are a longer-term process, with studies showing measurable changes over months to years of consistent, high-intensity therapy [1.3.4, 1.11.2].

No supplement has been proven to remove plaque in the same way as prescription medications like statins or PCSK9 inhibitors. While a healthy diet is critical, claims about specific supplements 'unclogging' arteries are not supported by robust scientific evidence [1.2.2, 1.7.4].

The most commonly discussed side effect is muscle aches. A modest increased risk of developing type 2 diabetes also exists for some individuals. However, for most at-risk patients, the benefits in preventing heart attack and stroke far outweigh the risks [1.3.3].

PCSK9 inhibitors are more powerful at lowering LDL cholesterol than statins. They are typically not a first-line therapy but are used for patients who cannot reach their LDL goal with statins alone, are intolerant to statins, or have very high genetic cholesterol [1.2.2].

No, aspirin does not remove or reduce plaque. Its function is to thin the blood and prevent platelets from sticking together to form a clot if a plaque ruptures, thereby helping to prevent a heart attack or stroke [1.2.1, 1.2.4].

Very intensive lifestyle changes, including a strict diet and exercise regimen, have been shown to shrink plaque [1.2.3]. However, for most people with established disease, medication is a necessary component to effectively lower cholesterol to the target levels needed for plaque regression [1.2.2].