[Can drugs, especially calcium antagonists, bring about regression of atherosclerosis, especially coronary...

The feasibility of true regression of human atherosclerotic plaques (reduction in volume) through drug therapy is still debated; the increase in coronary artery diameter, especially eccentric stenoses during massive reduction of serum cholesterol, can also be due to stabilization of endothelial function and improvement of the abnormally raised basal coronary tone. Today, there are two groups of substances with anti-atherosclerotic properties: lipid-lowering drugs, and calcium-entry blockers. As evidenced both from animal experiments and prospective studies in man by quantitated coronary angiography (QCA), the latter act mainly by retarding the evolution of new plaques, and possibly even of fatty streaks. In man, four studies with calcium-entry blockers so far exist, all demonstrating a significant reduction (average -46%) of new lesions (stenoses and occlusions) in previously angiographically normal segments. To what extent these favourable anatomical results will lead to an improvement of cardiac events caused by plaque rupture (unstable angina, myocardial infarction) later on is still an open question. The slow anatomical progression of coronary artery disease, as evidenced by prospective repeated QCA, calls for studies with long-term follow-ups (10 and more years) and large numbers of patients.