FEMORAL AND CORONARY ANGIOGRAPHIC TRIALS

A number of large-scale clinical trials have demonstrated that lipid-altering therapy is associated with a reduced risk of coronary artery disease events. The mechanism of benefit has been postulated to be related to favorable effects at the level of the arterial wall. Angiography allows direct examination of the effects of lipid-altering therapy on the arterial wall and extensive angiographic trial data are now available. Coronary angiographic trials, employing various patient populations, therapies and endpoint measures, have demonstrated slowed progression and increased regression of atherosclerosis in the coronary tree. Femoral artery trials (which might be considered as surrogate for coronary artery trials) have also shown significant regression of atherosclerosis in treated patients. There are pros and cons for all of the various atherosclerosis change measurement techniques, but coronary artery disease events remain the ''bottom line'' of concern. In this regard, the Program on the Surgical Control of the Hyperlipidemias (POSCH) trial is valuable since the 3-year human consensus panel-derived global coronary change score predicted subsequent coronary events. Yet to be determined are which quantitative coronary angiography measures predict events. Finally, given the number of therapeutic questions that remain, the most promising opportunity for future antiatherosclerosis research may lie in the use of ultrasound to evaluate changes in the carotid arteries.