Clinical & Experimental Cardiology
Open Access

Abstract

The Regression of Atherosclerosis: The Power of Multimodality Imaging

Jonathan E Feig, Jessica L Feig and Annapoorna S Kini

Coronary artery disease remains a leading cause of death in the Western world. It is well known that the reduction of cholesterol levels by statin therapy is associated with significant decreases in plaque burden. However, a critical question has been the ability of statin therapy to lead to lipid egress from plaque and subsequent plaque stabilization. This is crucial since lipid-rich coronary plaques are at increased risk for rupture and thrombus leading to events. We recently addressed this issue by conducting the YELLOW (reduction in yellow plaque by aggressive lipid-lowering therapy) trial. We reported that short-term intensive statin therapy reduces lipid content as assessed by near infrared spectroscopy (NIRS) in obstructive lesions. Histopathological studies suggest that the majority of acute coronary events are related to occlusive thrombus formation after disruption of a thin-cap fibroatheroma (TCFA) overlying a large necrotic lipid core. Optical coherence tomography (OCT) is an imaging modality with powerful resolution to allow for plaque characterization including the identification of TCFA. Yet, it still remains unknown as to the efficacy of high dose statin therapy for enhancing anatomic features of plaque stabilization. The YELLOW II Trial was therefore designed with the goal of combining the utilization of OCT and NIRS in the coronary arteries to extend our initial findings as well as link them to changes in plaque morphology with alterations in lipoprotein biology, HDL function and macrophage behaviour.