Atherosclerosis regression: is low-density lipoprotein or high-density lipoprotein the answer?

Lowering low-density lipoprotein cholesterol is the cornerstone of risk modification in patients with established coronary artery disease. Considerable attention is currently focused on developing pharmacologic agents that promote the biologic activity of high-density lipoprotein. Advances in imaging of the artery wall provide the opportunity to evaluate the impact of medical therapies on serial changes in plaque burden. A number of reports describe the favorable effects of interventions that lower low-density lipoprotein cholesterol or promote the biologic activity of high-density lipoprotein. The current state of evidence defining the relative contribution of changes in plasma lipids on the tendency to plaque regression is reviewed.