PIXEL OR DEATH - EXPERIENCE FROM CLINICAL-TRIALS ASSESSING LIPID-LOWERING THERAPY

Repeated coronary angiography has become a surrogate for clinical even ts in studies involving lipid lowering treatment, regression in approx imately 20% of subjects. Clinical events decreased more rapidly and mo re profoundly than can be explained by morphological remodeling. Regre ssion of atherosclerosis correlates well with reductions in serum low density lipoprotein (LDL) cholesterol and with increases in high densi ty lipoprotein (HDL) cholesterol. Although overall improvement in seve rity and extent of the disease was modest, reduction of clinical event s was impressive. Lipid modulation may stabilize existing lesions by i mproving the stability of the lesion cap and/or promoting loss of chol esterol content from within the plaque. Survival studies indicate that lipid lowering decreases morbidity and increases longevity in patient s with established coronary artery disease. The B-mode ultrasound stud ies using the carotid artery as surrogate for the assessment of athero sclerosis in coronary arteries seems extremely promising. The atherosc lerotic process as well as complications may be studied in an early st age using noninvasive methods.