Atherosclerotic plaque stabilization and regression: a review of clinical evidence

Can atherosclerosis be reversed, not just slowed? This Nature Reviews Cardiology review, from Steven Nissen’s group — pioneers of measuring plaque inside the artery — assembles the evidence that it can.

The throughline is LDL. Using intravascular ultrasound as the trial gold standard, a series of landmark studies (REVERSAL, ASTEROID, SATURN, and then GLAGOV with a PCSK9 inhibitor) showed that intensive LDL lowering doesn’t merely halt plaque growth — it shrinks plaque, and lower LDL means more regression, with no floor at which the benefit reverses. Just as important is stabilization: shifting plaque toward a composition (thicker fibrous cap, less lipid core) less likely to rupture. The authors are candid that HDL-raising strategies have repeatedly failed to deliver regression, and that residual risk persists — pointing to Lp(a), inflammation, and triglyceride-rich lipoproteins as the next targets.

The practical takeaway is motivating and concrete: aggressive LDL lowering can measurably reverse disease, lower is better, and non-invasive CT angiography is emerging to track plaque in practice.

We rate the evidence high: a high-impact review from a world authority, synthesizing the imaging-trial evidence base, though narrative in form. Its clinical significance is high — “atherosclerosis is reversible” reframes how aggressively to treat and how to counsel patients, anchoring the case for intensive lipid management in visible plaque change.