ABSTRACT
Recent large clinical trials detailed elsewhere in this volume have confirmed that lipid therapy in selected patients reduces substantially the risk of clinical cardiovascular events without causing other clinical morbidity. Earlier trials examining the effect of lipid-altering therapy on the coronary artery had already provided compelling evidence for clinical benefit, and identified a spectrum of dynamic changes in the coronary stenosis that appear to explain these benefits and provide targets for more effective disease prevention. These advances in understanding have followed technical advancements in arterial and thrombus imaging, in assessment of vasomotion, and in techniques of vessel wall and plaque histomorphometry. In particular, the quantitative arteriographic finding that intensive lipid therapy dramatically reduces the frequency of episodes of major plaque instability has been an observation central to understanding the mechanism of therapy benefit. This finding has caused us to reexamine a number of important related observations, and has fostered a new generation of studies probing plaque structure and biology for further insight.
