The Present and Future
JACC State-of-the-Art Review
Coronary Atherosclerotic Plaque Regression: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2021.10.035Get rights and content
Under an Elsevier user license
open archive

Highlights

  • Plaque progression precedes cardiovascular events.

  • Improvements in coronary imaging modalities allow direct assessment of plaque modification.

  • If outcome data linking plaque regression to reduce CV events emerge, monitoring the response to coronary plaque treatment may ultimately supersede surrogate markers like risk scores and lipoprotein levels.

Abstract

Over the last 3 decades there have been substantial improvements in treatments aimed at reducing cardiovascular (CV) events. As these treatments have been developed, there have been parallel improvements in coronary imaging modalities that can assess plaque volumes and composition, using both invasive and noninvasive techniques. Plaque progression can be seen to precede CV events, and therefore, many studies have longitudinally assessed changes in plaque characteristics in response to various treatments, aiming to demonstrate plaque regression and improvements in high-risk features, with the rationale being that this will reduce CV events. In the past, decisions surrounding treatments for atherosclerosis have been informed by population-based risk scores for initiation in primary prevention and low-density lipoprotein cholesterol levels for titration in secondary prevention. If outcome data linking plaque regression to reduced CV events emerge, it may become possible to directly image plaque treatment response to guide management decisions.

Key Words

atherosclerotic plaque
coronary artery disease
imaging
ischemic heart disease
plaque modification

Abbreviations and Acronyms

ACS
acute coronary syndromes
CCTA
coronary computed tomography angiography
CETP
cholesteryl ester transfer protein
CMR
cardiac magnetic resonance
EPA
eicosapentenoic acid
IVUS
intravascular ultrasound
LDL-C
Low-density lipoprotein-cholesterol
MACE
major adverse cardiovascular events
NIRS
near infrared spectroscopy
OCT
optical coherence tomography
OMT
optimal medical therapy
PET
positron emission tomography
TAV
total atheroma volume

Cited by (0)

Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on JACC.org.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.