Reversing coronary atherosclerosis. How to put findings of recent trials to practical use.

The value of aggressively modifying lipid levels in patients who have established coronary artery disease has been clarified by recent studies. Diet or drug programs that lower low-density lipoprotein (LDL) cholesterol levels to 100 mg/dL or less may halt disease progression and reverse preexisting arterial plaques. The safety of these programs has been demonstrated, and trends toward improved survival time have been observed in the larger studies. Improvement in anginal control and clinical stability, with fewer required coronary revascularization procedures, are also noted with this therapy. All patients with established coronary artery disease should undergo fasting lipid profiles, including measurements of LDL and high-density lipoprotein cholesterol fractions. Dietary and drug therapy if necessary should be offered to achieve the target LDL cholesterol level. Ongoing studies will further clarify the role of newer lipid-lowering agents and potential benefits of noninvasive monitoring techniques in patients with atherosclerosis.