# Current Treatments

* [Cilostazol/Pletal (wikipedia.org)](https://en.wikipedia.org/wiki/Cilostazol), 100mg
* Ranolazine/Ranexa
* Clopidogrel/Plavix
* Exercise - Walking
* [Vorapaxar (wikipedia.org)](https://en.wikipedia.org/wiki/Vorapaxar)

## Hypertension (2020)

* Lisinopril

# Possible Treatments

## Better 

### Cyclodextrin

#### TL;DR
	* Direct (murine) and indirect (human, Niemann-Pick type C)
	  experimental evidence of efficacy for treating and _reducing_
	  plaque and calcified plaque.
	* BUT, requires intravenous delivery.
	* Only treatment that might _reverse_ atherosclerosis. PPARG
	  agonists might at best slow or stop progression. Current
	  treatments are just disease management.
	* [Sweet Drug Clears Cholesterol... (arstechnica.com)](http://arstechnica.com/science/2016/04/sweet-drug-clears-cholesterol-reverses-heart-disease-and-was-found-by-parents/)

#### Studies
	* [Cyclodextrin promotes atherosclerosis regression via macrophage reprogramming (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/27053774)
		* "Mechanistically, CD increased oxysterol production in both macrophages and human atherosclerotic plaques and promoted liver X receptor (LXR)-mediated transcriptional reprogramming to improve cholesterol efflux and exert anti-inflammatory effects. In vivo, this CD-mediated LXR agonism was required for the antiatherosclerotic and anti-inflammatory effects of CD as well as for augmented reverse cholesterol transport. Because CD treatment in humans is safe and CD beneficially affects key mechanisms of atherogenesis, it may therefore be used clinically to prevent or treat human atherosclerosis."
		* CD = 2-hydroxypropyl-\(\beta\)-cyclodextrin
		* Administration: This study used subcutaneous administration. Various other sources suggest that oral administration not effective in animals--passes to colon and broken down by microflora.
		  See, e.g. [this paper](http://www.inchem.org/documents/jecfa/jecmono/v32je13.htm)
		  and [this paper](http://www.ema.europa.eu/docs/en_GB/document_library/Report/2014/12/WC500177936.pdf).
		  Therapeutic effects with oral administration in other studies probably resulted from different mechanisms than in this
		  study, at least in as much as the effects were real and substantial.
	* [Treatment with KLEPTOSE CRYSMEB reduces mouse atherogenesis by impacting on lipid profile and Th1 lymphocyte response (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/25921922)
		* Conflict of Interest: Roquette produces food, cosmetic, and medical products from agricultural waste. Fortunately for them cyclodextrins are typically refined from corn.
		* Administration: Intraperitoneal. See above.
	* [Dietary alpha-cyclodextrin lowers low-density lipoprotein cholesterol and alters plasma fatty acid profile in low-density lipoprotein receptor knockout mice on a high-fat diet (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/18640380)
	* [Osteoclast formation, survival and morphology are highly dependent on exogenous cholesterol/lipoproteins. (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/15017384)
	* [Inhibition of smooth muscle cell proliferation and experimental angioplasty restenosis by beta-cyclodextrin tetradecasulfate (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/8499413)
	* [Cellular cholesterol efflux mediated by cyclodextrins (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/7615524)

### PPAR-\(\gamma\) (PPARG) agonists

	* [Insights into How Calcium Forms Plaques in Arteries Pave the Way for New Treatments for Heart Disease (plos.org)](http://journals.plos.org/plosbiology/article?id=10.1371%2Fjournal.pbio.1001533)
		* "But this effect was prevented by simultaneous treatment with the PPAR\(\gamma\)-activating drug, which decreased the infiltration of osteoblasts into the plaques while increasing the infiltration of osteoclasts."
	* Thiazolidinediones
		* [PPARgamma and atherosclerosis (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/15811195)
	* Metformin - Moderate PPARG agonist, among other things. From
	  epidemiological perspective could maybe be given to everybody to
	  reduce all-cause mortality, absent contraindictions.
	  Well-tolerated and a hot-bed of research at top labs.

## Lesser

* [Phosphatidylcholine (preventivecardiologist.wordpress.com)](https://preventivecardiologist.wordpress.com/2012/08/09/dissolve-arterial-plaque-with-phosphatidylcho/comment-page-1/)
* [NanobacTX (nanobiotechpharma.com)](http://www.nanobiotechpharma.com/)
	* [FDA warning letter (fda.gov)](http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm435675.htm)
	* [Discusson (longecity.org)](http://www.longecity.org/forum/topic/75210-anti-atherosclerotic-nanobactx/)
	* [EDTA chelation therapy (ncbi.nlm.nih.gov)](http://www.ncbi.nlm.nih.gov/pubmed/25023079)
		* [Analysis (mayoclinic.org)](http://www.mayoclinic.org/medical-professionals/clinical-updates/cardiovascular/results-trial-assess-chelation-therapy-tact-study-presented); statistically significant but minimal results.

# Notes

## June 11, 2019

* https://news.ycombinator.com/item?id=20156425
* https://www.cam.ac.uk/research/news/cause-of-hardening-of-the-arteries-and-potential-treatment-identified
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585988/
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663571/#sec2-nutrients-07-05443title

Last updated: June 17, 2019 by william@hitzke.com

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