Pixel or death: experience from clinical trials assessing lipid lowering therapy

Repeated coronary angiography has become a surrogate for clinical events in studies involving lipid lowering treatment. Different lipid lowering interventions have resulted regression in approximately 20% of subjects. Clinical events decreased more rapidly and more profoundly than can be explained by morphological remodeling. Regression of atherosclerosis correlates well with reductions in serum low density lipoprotein (LDL) cholesterol and with increases in high density lipoprotein (HDL) cholesterol. Although overall improvement in severity and extent of the disease was modest, reduction of clinical events was impressive. Lipid modulation may stabilize existing lesions by improving the stability of the lesion cap and/or promoting loss of cholesterol content from within the plaque. Survival studies indicate that lipid lowering decreases morbidity and increases longevity in patients with established coronary artery disease. The B-mode ultrasound studies using the carotid artery as surrogate for the assessment of atherosclerosis in coronary arteries seems extremely promising. The atherosclerotic process as well as complications may be studied in an early stage using noninvasive methods.