Purpose of review: To highlight clinical trials that have employed coronary artery imaging to evaluate the impact of medical therapies that target established cardiovascular risk factors.
Recent findings: High resolution imaging of the entire vessel wall permits assessment of changes in the full extent of coronary atherosclerosis. Intensive lowering of LDL cholesterol and systolic blood pressure are associated with the greatest benefit in terms of slowing disease progression. Therapeutic approaches that promote the biological activity of HDL have the potential to promote regression of atherosclerotic plaque. Targeting inflammatory cascades may also have a beneficial effect on the extent and composition of coronary plaque.
Summary: Intensive modification of established risk factors has a profound impact on the natural history of atheroma progression.