Therapies leading to coronary atherosclerosis plaque regression: a scientific statement of the European Association of Preventive Cardiology, the European Association of Cardiovascular Imaging of the ESC, the ESC Working Group on Atherosclerosis and Vascular Biology, and the ESC Working Group on Cardiovascular Pharmacotherapy Part 1: Atherosclerosis Pathophysiology and Imaging Evaluation

Edoardo Conte; Francesco Perone; Bernard Cosyns; Marc R Dweck; Erwan Donal; Isabel Goncalves; Borja Ibanez; Juan Carlos Kaski; Pal Maurovich-Horvat; Yoshinobu Onuma; Elena Osto; Marcio Sommer Bittencourt; Patrick Washington Serruys; Daniele Andreini

doi:10.1093/eurjpc/zwaf594

Therapies leading to coronary atherosclerosis plaque regression: a scientific statement of the European Association of Preventive Cardiology, the European Association of Cardiovascular Imaging of the ESC, the ESC Working Group on Atherosclerosis and Vascular Biology, and the ESC Working Group on Cardiovascular Pharmacotherapy Part 1: Atherosclerosis Pathophysiology and Imaging Evaluation

Eur J Prev Cardiol. 2025 Nov 6:zwaf594. doi: 10.1093/eurjpc/zwaf594. Online ahead of print.

Authors

Edoardo Conte¹, Francesco Perone², Bernard Cosyns^{3

4}, Marc R Dweck⁵, Erwan Donal⁶, Isabel Goncalves⁷, Borja Ibanez⁸, Juan Carlos Kaski⁹, Pal Maurovich-Horvat¹⁰, Yoshinobu Onuma¹¹, Elena Osto^{12

13}, Marcio Sommer Bittencourt¹⁴, Patrick Washington Serruys¹⁵, Daniele Andreini¹⁶

Affiliations

¹ Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant'Ambrogio Hospital IRCCS, via Cristina Belgioioso 173, 20100 Milan, Italy.
² Cardiac Rehabilitation Unit, Rehabilitation Clinic 'Villa delle Magnolie', Castel Morrone, 81020 Caserta, Italy.
³ Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium.
⁴ Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Av. du Laerbeek 101, 1090 Jette, Belgium.
⁵ BHF Centre for Cardiovascular Science, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
⁶ Department of Cardiology, University of Rennes, CHU Rennes, INSERM, 2 Rue Henri Le Guilloux, 35033 Rennes, France.
⁷ Department of Cardiology and Cardiovascular Research Translational Studies, Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28 Malmö, Sweden.
⁸ Centro Nacional de Investigaciones Cardiovasculares (CNIC) & IIS-Fundación Jiménez Díaz University Hospital, UAM & CIBERCV, Melchor Fernández Almagro, 3, 28029 Madrid, Spain.
⁹ St. George's University Hospitals NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
¹⁰ Department of Radiology, Medical Imaging Center, Semmelweis University, Üllői út 78a, 1082 Budapest, Hungary.
¹¹ Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland; Department of Cardiology, Saolta Group, Galway University Hospital Health Service Executive and University of Galway, Galway, Newcastle Rd, Galway H91 YR71, Ireland.
¹² Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zürich, Switzerland.
¹³ Division of Physiology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
¹⁴ Division of Cardiology, Department of Medicine, University of Pittsburgh, 200 Delafield Rd #3010, Pittsburgh, PA 15215, USA.
¹⁵ National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK.
¹⁶ Department of Biomedical and Clinical Sciences, University of Milan, Via Carlo Pascal, 36, 20133 Milano MI, Italy.

PMID: 41206214
DOI: 10.1093/eurjpc/zwaf594

Abstract

Coronary artery disease is one of the leading causes of mortality worldwide. While early identification and treatment of major cardiovascular risk factors are crucial, recent data suggest the possibility of non-invasively detecting early stages of coronary atherosclerosis and potentially stabilizing or even reversing the burden of atherosclerosis with innovative and existing treatments. Moreover, therapies from lipid-lowering to anti-inflammatory drugs were recently demonstrated to influence atherosclerosis progression and potentially lead to different grades of plaque regression. The present is Part 1 of a scientific consensus document divided into two separate manuscripts. This first part provides an up-to-date scientific statement on the pathophysiology mechanism of atherosclerosis progression and regression and on the role of invasive and non-invasive imaging techniques in evaluating and quantifying plaque.

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