Can atherosclerosis regress? The role of the vascular extracellular matrix and the age-related changes of arteries.
BACKGROUND
Previous extensive clinical studies, using angiography or ultrasound, investigated the influence of alimentary, medicamentous and other antiatherosclerotic measures on the degree of atherosclerosis. The following signs of regression were found: clinical improvement, changes in tonus of vascular walls, formation of collateral vessels or reduced occurrence of circulatory disturbances. Evidence of a diminution of plaque size was hardly ever produced from appropriate procedures in human pathology. A clear differentiation of regression and stop of progression was generally not possible.


OBJECTIVE
Causes of the difficulties arising in the evaluation of the atherosclerotic process are analyzed based on a review of the current literature. Prospects of regression in different forms of atherosclerosis were discussed.


CONCLUSIONS
The strength of imaging diagnostics is limited above all by the remodeling of vascular walls, interfering age-related changes in arteries and the heterogeneity of atherosclerotic lesions in addition to the extremely protracted course of atherosclerosis matched by a corresponding extremely slow regression. Early lesions up to the preatheroma as classified by Stary et al. [Arterioscler Thromb Vasc Biol 1995;15:1512-1531] are considered reversible. Advanced lesions can probably be stabilized by antiatherosclerotic measures. Knowledge of collagen composition, proteoglycans, matrix metalloproteinases and other constituents of the vascular extracellular matrix as well as the histoarchitecture of atherosclerotic plaques using magnetic resonance tomography opens up new prospects for the assessment of regression of atherosclerosis.
Kunz
J
J
D000375:Aging / Q000502:physiology*; D000818:Animals; D001161:Arteriosclerosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D004036:Diet, Atherogenic; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000737:chemistry / Q000473:pathology; D005109:Extracellular Matrix / Q000502:physiology*; D006801:Humans; D012043:Regression, Psychology; D012307:Risk Factors