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Am J Cardiovasc Drugs. 2008;8(6):365-71. doi: 10.2165/0129784-200808060-00003.

Candidate mechanisms for regression of coronary atherosclerosis with high-dose statins: insight from intravascular ultrasonography trials.

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Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195, USA.


Animal models and serial imaging studies in humans have shown that atherosclerosis is a potentially reversible disease. Several drug classes have been tested to determine whether they can promote reversal of atherosclerosis. Of these, HMG-CoA reductase inhibitors (statins) have been consistently proven to have anti-atherosclerotic effects in large-scale clinical trials. In this article, we review the lipid- and non-lipid-based mechanisms of statin-induced disease regression using the information provided by the recent intravascular ultrasonography trials. We conclude that, despite several potential mechanisms, reduction of low-density lipoprotein cholesterol appears to be the dominant mechanism responsible for regression of atherosclerosis.

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