Clinical investigations of the arrest and reversal of coronary artery disease

Trials of lipid-lowering therapy with angiographically monitored endpoints have demonstrated that regression of atherosclerosis can be achieved. Additionally, the unexpected clinical benefit seen in some trials has suggested that stabilization of lesions may be even more important clinically than regression, and more readily achievable. However, much additional research is needed to clarify the effects of therapy on the heterogeneous population of lesions and the precise mechanisms by which such therapy influences event rates. It is nonetheless clear that aggressive lowering of LDL cholesterol is indicated in patients with established coronary disease, who are at high risk for future events. Accordingly, the new guidelines of the USA National Cholesterol Education Program (NCEP) have adopted an LDL cholesterol goal of less than 100mg/dl (2.6 mmol/l) in patients with confirmed atheroslerotic disease. Ongoing and future strategies for investigating lipid-lowering therapy and the progression of atherosclerosis include new imaging modalities, such as ultrasonography of the carotid arteries and PET scanning, and use of more potent lipid-lowering interventions.