Regression of atherosclerosis: Does it occur and does it have clinical meaning?

Brown, B. Greg; Zhao, Xue-Qiao; Poulin, Drew; Albers, John J.

doi:10.1093/eurheartj/16.suppl_e.2

Cited by 8 publications

(4 citation statements)

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“…SCIMO demonstrated a magnitude of effect of dietary n-3 fatty acids on the course of coronary atherosclerosis that is similar to the magnitude of effect seen in studies with a similar design, using other approaches such as cholesterol-lowering, lifestyle changes, or vigorous exercise (25). A smaller study with a less homogeneous patient population, using a different placebo, showed no effect of dietary n-3 fatty acids (26).…”

Section: Discussionsupporting

confidence: 51%

The effect of n−3 fatty acids on coronary atherosclerosis: Results from SCIMO, an angiographic study, background and implications

Schacky

Baumann

Angerer

2001

Lipids

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According to the model of "response to injury," the arterial endothelium is occasionally injured in hyperlipidemia, hypertension, diabetes mellitus and in other states known as risk factors. The ensuing inflammatory response is modulated by cytokines and growth factors, among them platelet-derived growth factor (PDGF), and monocyte chemoattractant protein-1 (MCP-1). In two independent studies, we demonstrated that mRNA levels for PDGF-A and -B and for MCP-1 are reduced after ingestion of n-3 fatty acids by human volunteers. This reduction persists after monocyte stimulation/differentiation by adherence. Moreover, the reduction is brought about only by dietary n-3 fatty acids and not by other classes of unsaturated fatty acids (n-6 or n-9). This appears to be one major mechanism of action of reduced progression/increased regression of established coronary artery disease by ingestion of 1.5 g/d n-3 fatty acids, as assessed by coronary angiography in a randomized placebo-controlled double-blind intervention study in 223 patients. The study was conducted according to "Good Clinical Practice," comprehensive rules regulating investigations with pharmaceutical compounds. Together, our investigations lend support to the importance of PDGF-A, PDGF-B, and MCP-1 in the pathogenesis of atherosclerosis, and the beneficial role of n-3 fatty acids therein.

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Section: Discussionsupporting

confidence: 51%

The effect of n−3 fatty acids on coronary atherosclerosis: Results from SCIMO, an angiographic study, background and implications

Schacky

Baumann

Angerer

2001

Lipids

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“…With the use of quantitative coronary angiography (QCA), the regression of atherosclerosis in humans has been defined indirectly in terms of arteriographic improvement in stenosis, which is expressed as increase in luminal area in the stenotic vessel. 51 The quantitative term ⌬ (% S) used to designate progression with a plus sign or regression with a minus sign denotes the average change in percent stenosis over all the lesions measured per patient. With the advent of effective lipid-lowering therapy, many randomized secondary prevention angiographic trials were initiated and provided information concerning the magnitude of regression.…”

Section: Regression Of Advanced Lesionsmentioning

confidence: 99%

“…A summary of 7 trials showed an improvement in ⌬ (% S) that ranged from Ϫ0.7% to Ϫ2.2% in stenosis in the treated patients, whereas the ⌬ (% S) worsened from ϩ0.8% to ϩ3.4% of luminal area in controls. 51 There are some caveats that have to be taken into account when using this method; improvement in lumen size can occur independent of changes in plaque size due to remodeling of the vascular wall 54 or relaxation of the vascular tone. 55,56 Spurious increase in the lumen may also result from lysis of occluding or mural thrombi.…”

Section: Regression Of Advanced Lesionsmentioning

confidence: 99%

Does Therapeutic Intervention Achieve Slowing of Progression or Bona Fide Regression of Atherosclerotic Lesions?

Stein

2001

ATVB

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Abstract-This review focuses on the regression of atherosclerosis in humans and experimental animals. It highlights the difficulties to determine unequivocally whether with a given therapeutic intervention, such as diet, drugs, or apheresis, the progression of lesions was curtailed or bona fide regression of atherosclerotic lesions was achieved. It seems appropriate to mention that 2 very different ways to measure regression were used in experimental animals and in humans. Regression in animals was determined mainly in the aorta or coronary arteries isolated at post mortem, and the criteria used were degree of sudanophilia and/or aortic wall thickness and cellular composition or cholesterol content. In humans, the evaluation of regression relied mainly on quantitative coronary angiography. The literature of the past decade is reviewed selectively but not exhaustively, and in some instances, a brief historical overview is given.

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“…Depending on the outcome measure, 64% to 78% of the patients showed regression of disease, significantly more than in the older angiographic progression-regression trials, in which the fraction of patients with regression was between 7% and 41%. 17 The remarkably more common occurrence of regression in the ASTEROID trial compared with the angiographic trials is probably explained by two factors:…”

Section: Convincing Evidence For Regressionmentioning

confidence: 99%

Coronary atherosclerosis can regress with very intensive statin therapy.

Sipahi

Nicholls

Tuzcu

et al. 2006

Cleveland Clinic Journal of Medicine

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The ASTEROID trial (JAMA 2006; 295:1556-1565) showed that very intensive statin therapy with rosuvastatin 40 mg once daily results in highly significant regression of coronary atherosclerosis as assessed by serial intravascular ultrasonography (IVUS). The mean low-density lipoprotein cholesterol (LDL-C) level achieved with this regimen was 61 mg/dL, and the mean highdensity lipoprotein cholesterol (HDL-C) level increased by 15%. While the merits of concomitant LDL-C-lowering and HDL-C-raising therapies remain to be determined, the results of the ASTEROID and other recent trials suggest that the optimal strategy for lipid-lowering in patients with coronary artery disease is to try for the lowest LDL-C level that can be attained without adverse effects. ■ KEY POINTS Coronary IVUS is inherently a more sensitive method of monitoring atheroma progression and regression than coronary angiography.

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Regression of atherosclerosis: Does it occur and does it have clinical meaning?

Cited by 8 publications

References 0 publications

The effect of n−3 fatty acids on coronary atherosclerosis: Results from SCIMO, an angiographic study, background and implications

The effect of n−3 fatty acids on coronary atherosclerosis: Results from SCIMO, an angiographic study, background and implications

Does Therapeutic Intervention Achieve Slowing of Progression or Bona Fide Regression of Atherosclerotic Lesions?

Coronary atherosclerosis can regress with very intensive statin therapy.

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