Progression and regression of coronary atherosclerosis : role of diet, lipoproteins and lipases

The evolution and natural course of human coronary artery disease and risk factor mitigation programs can be studied by comparing sequential coronary angiograms of the same patient at different moments in time.1 Although tens of thousands of angiograms are performed each year to elucidate the possible anatomical substrate of clinical manifestations, a very limited number is carried out to assess the effects of an intervention with the aim to decelerate the natural progression of coronary artery disease. As having a distorted lipid metabolism is one of the main risk factors which tend, if uncorrected, to accelerate the natural course of coronary atherosclerosis, several studies have been published that focus on the effect of lipid lowering on coronary atherosclerosis. A clear relationship between lipoprotein concentrations and severity of atherosclerosis has been shown to exist,23 and the results of nine intervention studies with regard to coronary atherosclerosis, carried out between 1975 and 1985 are summarizes in Table I. A brief description of these follows