[Regression of coronary atherosclerosis: possible--and clinically relevant?]

Several recent clinical trials have shown that in male patients with stable coronary heart disease, progression of atherosclerosis can be delayed even in short time. The interventions to bring about less progression and even a regression of coronary artery lesions mainly consisted in lowering high lipid levels, either with drugs, partial ileal bypass surgery or comprehensive lifestyle changes. The results of trials using calcium antagonists were less consistent and failed to show clear-cut slowing or prevention of progression. Some questions, however, arise and are discussed: i.e. the shortcomings of quantitative angiography to assess the extent of atherosclerotic lesions and the clinical importance of the observed changes in luminal diameter, which tended to be small. Despite these intriguing issues, the reported studies provided the additional information that the angiographically demonstrated benefits were paralleled by a reduction of clinical vascular events and an improvement of the short-term clinical outcome.