Assessment of progression and regression of coronary atherosclerosis by coronary angiography

Quantitative coronary angiography (QCA) has been used for many years to study therapy effects. This became possible after a very high standardization of computer-assisted evaluation of coronary angiograms was introduced. The results of studies with various medications showed that the progression of coronary atherosclerosis could actually be inhibited. Reports on regression were rare and were in the range of 10 % of patients who showed such a response. In recent years only a few studies were carried out with QCA to test the effects of medications. Intravascular ultrasound is the new gold standard for recording coronary atherosclerosis. First rosuvastatin, later fluvastatin and simvastatin and recently rosuvastatin and atorvastatin were tested. Related to the progression and regression of coronary artery sclerosis, the data demonstrated that below a low-density lipoprotein (LDL) cholesterol threshold of 80 mg/dl patients developed regression and above this level progression was predominantly found. These results were similar to the studies using intravascular ultrasound; however, progression and regression are also related to the level of high density lipoprotein (HDL) cholesterol similar again to the level, which could be detected by intravascular ultrasound. Thus, not only intravascular ultrasound but also QCA should be used to study drug interactions with coronary atherosclerosis and particularly when new drugs are compared to statins.