[Is regression of atherosclerotic plaque possible?]

Area of Science:

• Cardiovascular Medicine
• Atherosclerosis Research
• Interventional Cardiology

Background:

• Acute coronary syndromes often result from thrombus formation on disrupted atherosclerotic plaques.
• Plaque stabilization, involving lipid core reduction and fibrous cap thickening, is a key mechanism for anti-atherosclerotic therapies.
• The 'angiographic paradox' highlights how lipid-lowering agents reduce events without significant lumen changes.

Purpose of the Study:

• To explore the role of plaque stabilization in the clinical benefits of anti-atherosclerotic strategies.
• To understand how lipid-lowering agents impact atherosclerotic plaque characteristics.
• To connect plaque burden reduction and cardiovascular event incidence with plaque stabilization.

Main Methods:

• Review of imaging modalities for non-invasive atherosclerosis assessment (e.g., vascular ultrasound, virtual histology, MRI, OCT, PET).
• Analysis of plaque volume and composition beyond lumen stenosis.
• Evaluation of the effects of 'aggressive' lipid-lowering strategies on plaque characteristics and cardiovascular events.

Main Results:

• Non-invasive imaging can assess plaque volume and composition, offering insights beyond lumen stenosis.
• Aggressive lipid-lowering strategies demonstrably reduce plaque burden.
• These strategies are associated with a decreased incidence of cardiovascular events.

Conclusions:

• Plaque stabilization is a significant mechanism underlying the benefits of anti-atherosclerotic therapies.
• Aggressive lipid-lowering contributes to cardiovascular event reduction, partly through plaque stabilization.
• Advanced imaging techniques are crucial for evaluating plaque modifications and therapeutic efficacy.