Purpose of review: This article reviews coronary atheroma regression with statin therapy.
Recent findings: Unlocking the mechanisms of atherogenesis and plaque progression has been fundamental to understanding the means by which contemporary antiatherosclerotic therapies lower cardiovascular risk. The advent of intracoronary imaging has helped chart the natural course of coronary atherosclerosis and evaluate therapeutic strategies that modify its natural progression. From earlier intravascular ultrasonography studies using lower dose statins to recent clinical trials evaluating the long-term effects of high-intensity statin therapies, our understanding of the relationship between incremental low-density lipoprotein-cholesterol lowering and coronary atheroma progression-regression has evolved considerably, particularly in patients of varying cardiometabolic risk including those with diabetes mellitus and acute coronary syndromes. Evaluating the impact of novel therapies on coronary atheroma using imaging will continue to be integral in establishing their mechanistic benefit prior to embarking on large-scale, expensive, long-duration randomized trials powered for clinical end points.
Summary: Statins have remarkably impacted the natural course of coronary atherogenesis. Intravascular imaging has proven crucial in evaluating the mechanisms by which we can curb coronary atheroma progression and induce its regression. The insights gleaned from intravascular imaging trials evaluating statins have been complementary to the findings from large-scale trials powered for clinical end points.