Candidate Mechanisms for Regression of Coronary Atherosclerosis with High-Dose Statins

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.