Reversal of Atherosclerosis with Therapy: Update of Coronary Angiographic Trials

Abstract

Publisher Summary There is now serial angiographic evidence for atherosclerotic lesion improvement induced by diverse modes of intervention. The weight of evidence indicates that atherosclerotic lesions as well as clinical coronary events are reduced by intervention. The Cholesterol-Lowering Atherosclerosis Study (CLAS) gave the first clear indication of the importance of triglyceride-rich lipoproteins in lesion progression-an effect manifested after LDL-C was removed as a risk factor. Although clinical events were not significantly different between drug and placebo groups during the 2 years of intervention, 10 year follow-up indicates a significantly lower clinical coronary event rate in the drug group. This chapter concentrates on familial atherosclerosis treatment study (FATS), NHLBl type II coronary intervention study, cholesterol-lowering atherosclerosis study (CLAS), research intervention trials, monitored atherosclerosis regression study (MARS), multicentre anti-atheroma study (MAAS), Heidelberg exercise-diet study, and the program on the surgical control of the hyperlipidemias (POSCH). Many interesting and important findings have resulted from coronary angiographic trials that need further attention if it is to increase our success with secondary preventive measures. The majority of the coronary angiographic trials, NHLBI Type II, CLAS, FATS, STARS, MARS, CCAIT, MAAS, Leiden Intervention Trial, and Lifestyle Heart Trial indicate that LDL-C reduction preferentially regresses lesions 250%S and typically retards coronary artery lesion progression in only 50 to 80% of subjects. Improved therapeutic regimens to alter progression of coronary atherosclerosis may require adjunctive therapy in concert with LDL-C reduction to prevent new lesion formation or to induce early lesion regression, such as for lesions