Summary
The results of various trials aided by newer modalities to study the atherosclerotic process provide ample evidence that it is not only possible to halt the relentless process of atherosclerosis but also to induce regression. Thus regression of atherosclerotic process is no longer a myth but a well-accepted reality, even though its extent is not very large. This reality has been elegantly articulated by William Roberts “If the serum cholesterol can be prevented from rising above 150mg/dl, plaques are not laid down, if elevated levels are lowered to 150mg/dl, further plaques do not form and part of those present may vanish”. The process can be modified favorably not only in case of chronic, but also in case of acute atherosclerosis. Besides statins and ACE inhibitors, multitudes of novel therapies are being tested and hold promise in future. Even though the success achieved in inducing regression of atherosclerotic lesions has been modest, it is a step in the right direction. No doubt further exciting research and prospects lie ahead in this field.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Forrester JS, Shah P. 1997. Lipid lowering versus revascularization. An idea whose time for testing has come. Circulation 96:1360–1362.
Enas EA, Jacob S, Joseph AK. 2000. Paradigm change from palliative to preventive cardiology: A critical review of mechanical coronary interventions versus comprehensive medical management. Asian J Clinical Card 3:21–52.
Oliver MF. 1992. Perspective of trials of regression of coronary atherosclerosis. Cardiovas. Risk Factors 2:234–248.
Anitschkow N, Chalatow S. 1983. On experimental cholesterin steatosis and its significance in the origin of some pathological processes, 1913. Reprinted in Arteriosclerosis 3:178–182.
Krieger H. 1997. The other side of scavenger receptors: pattern recognition for host defenses. Curr Opin Lipidol 8:275–280.
Stary HC, Chandler AB, Diusmore RE, et al. 1995. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis: A report from the committee on vascular lesions of the council on arteriosclerosis. American Heart Association. Circulation 92:1355–1374.
O’Brien, Garvin MR, Dev R, Stewart DK, Hinohara T, Simpson JB, Schwartz SM. 1994. Angiogenesis in human coronary atherosclerotic plaques. Am J Pathol 145:883–894.
Dollery CH, McEwan JR, Henney AM. 1995. Matrix mettaloproteinases and cardiovascular disease. Cir Res 77:863–868.
Amento EP, Ehsani N, Palmer H, Libby P. 1991. Arteriosclerosis and Thrombosis. Cytokines positively and negatively regulate interstitial collagen gene expression in human vascular smooth muscle cells. Arteriosclerosis 11:1223–1230.
Nigro J, Dilley RJ, Little PJ. 2002. Differential effects of gemfibrozil on migration, proliferation and proteoglycan production in human vascular smooth muscle cells (abstract). Elsevier Medical Journals. http://www.cardiosource.com.
Tangirala RK, Tsukamoto K, Chun SH, Usher D, Pure E, Rader DJ. 1999. Regression of atherosclerosis induced by Liver—directed gene transfer of apolipoprotein-A. Circulation 100:1816–1822.
Marjel J van Dam, Eric de Groot, Susanne M Clee, G Kess Hovingh, Roosje Roelants, Angie Brooks-Wilson, Aeiko H Zwinderman, Andries J Smit, August HM Smelt, Albert K Groen, Michael R Hayden, John JP Kastelein. 2002. Association between increased arterial wall thickness and impairment in ABCA1-driven cholesterol efflux: an observational study. Lancet 359:37–41.
Lipid Research Clinics Programme. 1984. The Lipid Research Clinics Coronary Primary Prevention Trial Results: I. Reduction in the incidence of coronary artery disease. JAMA 251:351–364.
Schedit S. 1992. Prevention of coronary artery disease: control of risk factors, potential new therapies and an update on regression CVR & R; 60–69.
Carl J Vaughan. 2000. The evolving role of statins in management of atherosclerosis. JACC 35(1):7-10.
MAAS Investigators. 1994. Effects of simvastatin on coronary Atheroma a Multicentric Antiatheroma Study. Lancet 344:633–638.
Bestohorn HP, Rewing UF, Roskanmutt, et al. 1997. The effect of simvastatin on coronary atheroma. Progression of coronary artery disease. The Multicentre Coronary Intervention Study (CIS). Eur Heart J 18:226–234.
Waters D, Higginson L, Gladstore P, et al. 1994. Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography. The Canadian Coronary Atherosclerotic International Trial. Circulation 89:959–968.
Jukema JW, Brusdike AVG, Van Boren AJ, et al. 1995. On behalf of the regress study group. Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study. Regress Circulation 91:2528–2540.
Blankenborn DIL, Azen SP, Krosch DM, et al. and the MARS Research group. 1993. Coronary angiographic changes with lovastatin therapy. The Monitored Atherosclerosis Regression Study (MARS). Ann Int Med 179:969–976.
Herd JA, Ballantyne CH, Farmer JA, et al. 1997. For the LCAS investigators. Effects of flurastatin on coronary atherosclerosis in mild and moderate cholesterol elevations (Lipoprotein and Coronary Atherosclerosis) Study (LCAS). Am J Cardiology 80:278–286.
Brown G, Albers JJ, Fisher LD, Schaefer SM, Lin JT, Kaplan C, Zhao XQ, Bisson BD, Fitzpatrick VF, Dodge HT. 1990. Regression of coronary artery disease as a result of intensive lipid lowering therapy in men with high levels of apolipoprotein B N Engl J Med 323:1289–1298.
Pignoli P, Iremoli E, Poli A, Oreste P, Paoletti R. 1986. Intimal plus medial thickening of the arterial wall: A direct measurement with ultrasound imaging. Circulation 14:1399–1406.
Mercuri H. 1996. Pravastatin reduces carotid intima media thickness progression in asymptomatic hypercholesterolemic midterm population. The CAIUS American Journal of Medicine 101(6):627–634.
Furberg CD, Adams HP Jr, Applegate WB, et al. 1994. For the Asymptomatic Carotid. Artery Progression Study (ACAPS) Research Group. Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Circulation 90:1679–1687.
Smilde TJ, Van Wissen, Wolesteim H, et al. 2001. Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolemia (ASAP): a prospective randomized double blind trial. Lancet 357:577–581.
Robert A O’Rourke, Bruce H Brundage, Victor F Froelicher, Philip Greenland, Scott M Grundy, Rory Hachamovitch, Gerald M Pohost, Leslee J Shaw, William S Weintraub, William L Winters. 2000. Electron beam computed tomography. Assessment of Progression or Regression of CHD by EBCT. JACC June, pp. 337–338.
Superko HR. 1996. Surprising clinical lessons from the regression trials. 21st Annual Tutorials in Teton. Educational Highlights of Am J Cardiology 11:1–4.
Little WC, Constantinescu M, Applegate RJ, Kutcher MA, Burrows MT, Kahl FR, Santamore WP. 1988. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild to moderate coronary artery disease? Circulation 78:1157–1166.
Rosenson RS, Tanghey CC. 1998. Antiatherothrombotic properties of statins: implications for cardiovascular event reduction. JAMA 29:1643–1650.
Gerard Paster Kamp, Erling Falk, Hein Woutman, Cornelius Borst. 2000. Techniques characterizing the coronary atherosclerotic plaque. Influence on clinical decision making? Visualization of the vulnerable plaque. JACC 36(1):13–21.
Daniell Pella. 2002. 2nd International Congress on Cardiovascular Diseases. PJ Safarik, University of Kosice, Slowakia). REVERSAL TRIAL Plaque Stability Role of Statins (Symposium).
Ornish D, Brown S, Scherwitz L, et al. 1990. Can lifestyle changes reverse coronary heart disease? The Life Style Heart Trial. Lancet 336:129–133.
Haskell WL, Aldesman EI, Fair JM, et al. 1994. Effects of intensive multiple risk factor reduction in coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention project (SCRIP). Circulation 89:975–990.
Susan A Everson, John W Lynch, Margaret A Chesney, George A Kaplan, Debbie E Goldberg, Starley B Shade, Richard D Cohen, Riitta Salonen, Jukka T Salonen. 1997. Interaction of workplace demands and cardiovascular reactivity in progress of carotid atherosclerosis: population based study. BMJ 314:553.
Eisa N Hjerkin. 2002. Anticipated first presentation. Diet and/or Omega 3 PUFA intervention trial on atherosclerosis. Ullevaal University Hospital Oslo, 0407 Norway. Elsevier Medical Journals. http://www.cardiosource.com.
Kam S Woo FRACP, FACC MD, Ping Chook MD, Yvette I Lolin PhD, John E Sanderson FACC MD, Con Metreweli FRCR MD, David S Celermajer FRACP PhD. 1999. Folic acid improves arterial endothelial function in adults with hyperhomocystenemia. J Am Coll Cardiol 34:2002–2006.
Sainani GS, Oxidative stress. 1997. A key factor in pathogenesis of chronic diseases. Medicine Update edited by YP Munjhal 7:1–10.
Eva M Lonn, Salim Yusuf, Vladimir Dzavik, C Ian Doris, Qlong Yi, Sandra Smith, Annie Moorelox, Jackie Bosh, Ward A Riby, Koon K Teo, for Secure investigators. 2001. The Study to Evaluate Carotid Ultrasound Changes in Patients Treated with Ramipiril and Vitamin E (SECURE) for Secure investigators. Circulation 103:919–925.
Stephens WG, Garsons A, Schofield PM, et al. 1996. Randomized control trial of vitamin E in patients with coronary disease. Coronary Heart Antioxidative Study (CHAOS). Lancet 347:781–786.
Normasa Yoshida. 2002. Inhibitory effect of a novel water soluble vitamin E derivative on atherosclerosis in rabbits (TMG) (Abstract) Elsevier Medical Journals http://www.cardiosource.com. Elsevier Science Ireland.
B Greg Brown MD, PhD, Xue-Qiao Zhao MD, Alan Chait MD, Lloyd D Fisher PhD, Marian C. Cheung PhD, Josh S Morse BS, Alice A Dowdy RD, Emily K Marino MS, Edward L Bolson MS, Petar Alaupovic PhD, Jiri Frohlich MD, Leny Serafini BS, Ellen Huss-Frechette BS, Shari Wang BS, Debbie DeAngelis RT, Arthur Dodek MD, John J Albers PhD. 2001. The HDL Atherosclerosis Treatment Study (HATS) (Simvastatin and Niacin, Antioxidant Vitamins, or the Combination for the Prevention of Coronary Disease). New Eng J Med 345:1583–1592 (Medline).
O’Wallidius Q Erikson, U Olsson AG, et al. 1994. The effect of probucol on femoral atherosclerosis. The PQRST (Probucol Qualitative Regression Sweedish Trial). Am J Cardiol 74:875–883.
Nave J. 1996. Selenium as a factor for cardiovascular disease. J Cardiovas Dis 3(1):42–47.
Klaus O Stumpe. 1993. PROTECT (Perindopril Regression of Vascular Thickening European Community Journal). J Hypertens 11(Suppl 5):S316–S317 (Medline). Am J Cardiol 1995;76:50E–54E (Medline).
Lichtlen PR, Hugenholtz PG, Raltlenbeul W, Hecker H, Jost S, Nikutta P, Deckers JW. 1996. Retardation of coronary artery disease in humans by the calcium channel blocker nifedipine: results of the INTACT study. International Nifedipine Trial on Antiatherosclerotic Therapy. Cardiovasc. Drugs Ther Aug 4(Suppl 5):1047–1068.
Jukema JW, Zwinderman AH, Van Boven AJ, Reiber JH, Van der Laarse A, Lie KI, Brusdhke AV 1996. Evidence for a synergistic effect of calcium channel blockers with lipid lowering therapy in retarding progression of coronary atherosclerosis in symptomatic patients with normal to moderately raised cholsterol levels. The Regress study group. Arterioscles Thromb Vas Biol 16:426–450. Elsevier Medical Journal. http://www.cardiosource.com.
Roxis—Gurfinkel E, Bozovicu G, Doraco A, et al. 1991. Randomized trial of roxithromycin or non-Q wave coronary syndrome. Roxis Pilot study. Lancet 350:404–417.
Mahlestein IB, Anderson JL, Cardquiet JF, et al. 2000. Randomized prevention trial of azithromycin in patients of coronary artery disease. Primary clinical results of the academic study. Circulation 102:1755–1760.
Stampfer MJ, Colditz GA, Willet WL, et al. 1991. Post-menopausal oestrogen therapy and cardiovascular disease. Ten year follow up from the Nurses Health Study. N Eng J Med 325:756.
Hulley S, Grady D, Bush T, et al. 1998. Randomized trial of oestrogen plus progestin for secondary prevention of coronary artery disease in post menopausal women. JAMA 280:605–613.
WELL-HART study (Women Estrogen Progestin Lipid Lowering Harmone Atherosclerosis Regression Study): Contacts Dr. Howard HODS 2250 Alxzar St CSC 132, Los Angles, California. watcher@hsc.uscedu. Elsevier Medical Journal. http://www.cardiosource.com
Aggarwal KK. 2001. Asian Journal of Cardiology, 4(2) (Editorial).
Saeid Babaei, Duncan J Stewart, Pierre Picard, Juan Carlos Monge. 2002. Effects of vasocare™ therapy on the initiation and progression of atherosclerosis. Elsevier Medical Journals, http://www.cardiosource.com.
Scott Gottlieb. 1999. Endostatin may stop the progression of atherosclerosis. BMJ 318:1030.
Maresta A, Balducall M, Cantini L, et al. 1994. For the STARC investigators, irazolopyremedine a platelet derived growth factor antagonist, reduces restenosis after PTCA. Circulation 90:2710–2715.
Billingham ME. 1992. Histopathology of graft coronary disease. J Heart Lung Transplant 11:338–344.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2003 Springer Science+Business Media New York
About this chapter
Cite this chapter
Kumar, A., Kaur, H., Devi, P., Mohan, V. (2003). Atherosclerotic Regression—A Myth or Reality. In: Dhalla, N.S., Chockalingam, A., Berkowitz, H.I., Singal, P.K. (eds) Frontiers in Cardiovascular Health. Progress in Experimental Cardiology, vol 9. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-0455-9_24
Download citation
DOI: https://doi.org/10.1007/978-1-4615-0455-9_24
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4613-5085-9
Online ISBN: 978-1-4615-0455-9
eBook Packages: Springer Book Archive