Constriction in response to serotonin is enhanced in the coronary arteries of atherosclerotic monkeys. The main objective of the present study was to determine whether abnormal responses to serotonin in atherosclerosis are reversed following removal of dietary cholesterol. In addition, we examined the effect of an atherogenic diet and reduction in dietary cholesterol on vascular responses to activation of ATP-sensitive K + channels with aprikalim. Diameters of small coronary arteries were measured on the epicardial surface of the left ventricle in vivo by using stroboscopic illumination synchronized to the heart cycle to visually freeze the motion of the heart. Diameters were measured with a microscope-video system during topical application of two vasoconstrictor agonists, serotonin and the thromboxane mimetic U46619, and the vasodilator agonists aprikalim and nitroprusside. Responses V ascular responsiveness to several agonists is altered by atherosclerosis, 17 and coronary vasoconstrictor responses to serotonin are augmented in patients with atherosclerosis or unstable angina. 56 Coronary microvessels relax in response to serotonin in normal monkeys and constrict in atherosclerotic animals.8 Thus, vasomotor abnormalities of atherosclerosis extend to the coronary microcirculation despite an absence of morphological evidence of disease.8 " A critical question is whether abnormal vascular responses in the atherosclerotic coronary circulation can be restored to normal by reducing dietary cholesterol. Reduction of dietary cholesterol reduces the intimal area of arteries as lipids are reabsorbed from the vessel wall.1214 Fibrosis progresses within the artery, however, so that maximal vasodilator responses do not improve consistently. 13 Nevertheless, studies in the hindlimb and cerebral circulation suggest improvement in vascular function after regression of atherosclerosis, with restoration of endothelium-dependent relaxation 15 and reduction in abnormal vasoconstriction in response to serotonin. 1617 It is unclear whether reductions in dietary cholesterol restore vascular reactivity of the coronary circulation to normal. The major objective of the present study was to determine whether reduction were compared in normal (n=9), atherosclerotic (n=14; highcholesterol diet), and regression (n=8; high-cholesterol diet followed by normal diet) monkeys. Constriction of coronary arteries in response to serotonin was enhanced in monkeys on an atherogenic diet and was normal in regression monkeys. Vasoconstriction in response to U46619 and vasodilation in response to nitroprusside and aprikalim were not altered by atherosclerosis. Thus, abnormal vascular responses to serotonin in small coronary arteries of atherosclerotic monkeys without morphological evidence of disease can be reversed to normal by reducing dietary cholesterol. (Arterioscler Thromb. 1994;14:951-957.) Key Words • serotonin • U46619 • aprikalim • nitroprusside • coronary resistance of dietary cholesterol in atherosclerotic monkeys abolishes v...