Achieving coronary plaque regression: a decades-long battle against coronary artery disease

ABSTRACT

Introduction

Traditionally atherosclerosis was thought to be progressive and medical treatment solely focused on delaying the progression of atherosclerosis rather than treating the disease itself. Multiple recent studies, however, have demonstrated a significant decrease in cardiovascular mortality with the use of additional anti-atherosclerotic therapies beyond statins. Consistent with these observations, mechanistic studies indicate that these additional anti-atherosclerotic therapies have a positive effect on both halting and reversing the course of atherosclerosis.

Areas Covered

We examine the progression of atherosclerosis and the efficacy of various anti-atherosclerotic treatment classes in this review utilizing multimodality imaging techniques. Searches were conducted in electronic databases: PubMed and EMBASE for all peer reviewed publications that examined coronary plaque progression, regression and stabilization using different imaging modalities and antiatherosclerosis therapies. All relevant published articles on this topic were identified and their reference lists were screened for relevance.

Expert Opinion

Though lipoprotein levels have traditionally been the target for antiatherosclerosis medication, several newer strategies have emerged creating novel targets in the treatment of coronary atherosclerosis. Using a combination of antiatherosclerosis therapies in conjunction with noninvasive imaging modalities like CCTA to directly visualize the plaque, is currently the focus of the future, with the aim of preventing and reversing atherosclerosis.

KEYWORDS:

• Atherosclerosis
• CAD
• plaque regression
• IVUS
• CCTA
• OCT

Article highlights

• Statin therapy has been the standard of care in the treatment of atherosclerosis for many years; however, there remains a significant residual risk of cardiovascular disease in many patients.

• New therapies are emerging which aim to not only treat lipoprotein levels but target various other mechanisms of atherogenesis and atherosclerosis progression. These therapies provide a more comprehensive approach to the treatment of atherosclerosis.

• Advancements in imaging modalities, such as IVUS and CCTA, have enabled us to detect atherosclerosis in its early stages and intervene prior to plaque growth and rupture, which lead to cardiovascular events.

• CCTA, as a non-invasive imaging modality, provides a detailed and comprehensive assessment of plaque in the entirety of the coronary tree with ease. Given the inexpensive and less cumbersome nature, the clinical utility of CCTA is rapidly growing.

• Evidence from multiple invasive and non-invasive imaging trials suggests that plaque regression from medical therapy is a realistic possibility. There is a need for additional research on plaque regression and its correlation with cardiovascular outcomes.

• Future research is focused on further understanding of the molecular pathogenesis of atherosclerosis. This may result in the discovery of novel anti-atherosclerosis therapies that could be used alone or in combination with currently available therapies to prevent and reverse atherosclerosis.

Author contributions

MJ Budoff conceived of the article idea. All authors were involved in literature search. The first draft of the manuscript was written by VS Manubolu, and all authors assisted with edits of the manuscript. All authors read and approved the final manuscript.

Declaration of Interest

MJ Budoff receives research support from General Electric (GE) and funding support from the National Institutes of Health (NIH).

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.