Regression of atherosclerosis

Abstract

<h2>Abstract</h2> This report summarizes the rationale, design and results of studies that have used serial angiography to evaluate the effects of dietary and drug therapy on coronary atherosclerosis. These prospective randomized trials characteristically use an observer panel or computer-assisted quantitative methods to assess change in angiographically recorded coronary lesions. Angiograms are performed in accordance with exacting standards that replicate angiographic projections and provide stable vascular tone. Angiographic trials, the first of which was the National Heart, Lung and Blood Institute Type II (NHLBI) coronary intervention study, have rapidly increased in number and diversity. In 1987, Blankenhorn et al. reported the results of the Cholesterol-Lowering Atherosclerosis Study (CLAS), which documented a decline in the rate of coronary disease progression, a decline in the number of new lesions and regression of existing lesions in native vessels in patients who had previously had bypass graft surgery. Similar beneficial results were observed with bypass grafts. The Program on the Surgical Control of the Hyperlipidaemias (POSCH) found that the beneficial effects of lipid-lowering therapy on angiographic measurements correlated with a decrease in the number of deaths and non-fatal myocardial infarctions during the 10-year follow-up. The Familial Atherosclerosis Treatment Study (FATS) and the Arteriosclerosis Specialized Center of Research (SCOR) trial have also demonstrated an improvement in angiographic measurements after aggressive hypolipidaemic therapy in patients with known coronary disease and substantially elevated blood lipid levels. The results from randomized trials reported to date suggest that, in patients with known coronary disease and hyperlipidaemia, aggressive lipid-lowering therapy reduces the rate of progression of arteriographic disease and, in a small number of patients, induces regression of existing coronary lesions.