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Atherosclerosis is a process leading to the narrowing and blockage of arteries. Initially, cholesterol in the blood deposit on the artery wall and form plague. The plague gradually enlarges and narrows the artery. Nevertheless, no symptoms may be observed until the plague ruptures and forms blood clot, resulting in complete blockage of the artery which can lead to severe cardiovascular events including heart attack, stroke and peripheral artery disease.

HMG CoA reductase inhibitors (Statins)
Statins work by inhibiting the production of LDL-cholesterol, preventing the formation of cholesterol plague on the artery wall. High-intensity statin e.g. Rosuvastatin is recommended for all patients with a high risk of cardiovascular events, even without clinical signs of hypercholesterolemia.

Antiplatelets
Antiplatelets prevent the formation of blood clot due to rupture of cholesterol plague. Low-dose Aspirin is the standard treatment due to well-established efficacy.

For patients with a recent cardiovascular event, Clopidogrel is commonly prescribed in combination with Aspirin as a dual antiplatelet therapy (DAPT) to prevent further cardiovascular event. Compared with Ticagrelor, Clopidogrel is associated with a lower risk of shortness of breath and major bleeding. It should be discontinued 7 days prior to any surgery.

In the course of any antiplatelet therapy, NSAIDs (e.g. Ibuprofen, Naproxen, Diclofenac) and SSRIs (e.g. Sertraline, Fluoxetine, Escitalopram) which may increase the risk of bleeding should be used with caution.