Arteriographic view of treatment to achieve regression of coronary atherosclerosis and to prevent plaque disruption and clinical cardiovascular events.

Lipid-lowering therapy, as assessed by angiography, clearly benefits the arterial disease process. For example, among intensively treated patients in FATS the frequency of definite progression per lesion at risk was reduced by 75% among mild and moderate lesions, which form the great preponderance of the lesion population. Regression frequency per lesion was more than doubled by intensive therapy in mild and moderate subgroups and quadrupled in the subgroup with severe lesions. Clinical events were reduced by 73%. This was clearly due to a 15-fold reduction in the likelihood that a mildly or moderately diseased arterial segment would undergo abrupt and substantial progression to a severe lesion at the time of the clinical event. It has been shown that the process of plaque fissuring, leading to plaque disruption, thrombosis, and clinical coronary events, is predicted by the size of the plaque core lipid pool and the abundance of lipid-laden macrophages in its fibrous cap. Experimentally, lipid lowering therapy decreases the number of lipid-laden intimal macrophages and more slowly depletes core cholesteryl ester deposits. Thus the composite of new and previously published data presented here supports the idea that lipid-lowering therapy selectively lipid-depletes (causes regression of) those fatty lesions containing a large lipid core and abundant intimal foam cells. By doing so, these lesions, which are most vulnerable to fissuring, are rendered much more stable and the clinical event rate is accordingly decreased.