Coronary Atherosclerotic Plaque Regression: JACC State-of-the-Art Review

J Am Coll Cardiol. 2022 Jan 4;79(1):66-82. doi: 10.1016/j.jacc.2021.10.035.


Over the last 3 decades there have been substantial improvements in treatments aimed at reducing cardiovascular (CV) events. As these treatments have been developed, there have been parallel improvements in coronary imaging modalities that can assess plaque volumes and composition, using both invasive and noninvasive techniques. Plaque progression can be seen to precede CV events, and therefore, many studies have longitudinally assessed changes in plaque characteristics in response to various treatments, aiming to demonstrate plaque regression and improvements in high-risk features, with the rationale being that this will reduce CV events. In the past, decisions surrounding treatments for atherosclerosis have been informed by population-based risk scores for initiation in primary prevention and low-density lipoprotein cholesterol levels for titration in secondary prevention. If outcome data linking plaque regression to reduced CV events emerge, it may become possible to directly image plaque treatment response to guide management decisions.

Keywords: atherosclerotic plaque; coronary artery disease; imaging; ischemic heart disease; plaque modification.

Publication types

  • Review

MeSH terms

  • Alcohol Drinking
  • Anticoagulants / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Cholesterol Ester Transfer Proteins / antagonists & inhibitors
  • Colchicine / therapeutic use
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / therapy*
  • Coronary Vessels / diagnostic imaging
  • Diagnostic Imaging / methods
  • Diet
  • Eicosapentaenoic Acid / therapeutic use
  • Exercise
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypoglycemic Agents / therapeutic use
  • Hypolipidemic Agents / therapeutic use
  • Life Style
  • Plaque, Atherosclerotic / diagnostic imaging
  • Plaque, Atherosclerotic / therapy*
  • Smoking Cessation


  • Anticoagulants
  • Antihypertensive Agents
  • Cholesterol Ester Transfer Proteins
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypoglycemic Agents
  • Hypolipidemic Agents
  • Eicosapentaenoic Acid
  • Colchicine