Circulation, Vol 79, 1-7, Copyright © 1989 by American Heart Association
DH Blankenhorn and DM Kramsch
In 1904, Marchand recognized the consistent association of fatty
degeneration and vessel stiffening and introduced the term
"atherosclerosis" to indicate this combination. Current research is focused
principally on the lipid component, but there is evidence that both aspects
are reversible. Atheromatous lipids add significantly to the volume of
lesions and thus contribute to vascular obstruction and end-organ damage.
Reversal of atherosis has been observed in all the major species used in
atherosclerosis research; rabbits, swine, dogs, chicks, pigeons, and
subhuman primates. Direct evidence for reversal in humans is based on
angiographic trials and is less extensive. One femoral artery and one
coronary artery trial indicate that the lesions can be stabilized. CLAS,
the largest angiographic trial to date, indicates that coronary lesion
reversal is possible. Clinical effects of sclerosis are more subtle, and
there is little evidence that sclerosis alone leads to end-organ damage.
However, it should be noted that atherosclerotic lesions producing
end-organ damage invariably have a major fibrous component. Sclerotic
vessels have reduced systolic expansion and abnormally rapid pulse wave
propagation, which can be measured noninvasively. Primate studies indicate
that sclerosis is induced by hypercholesterolemic diets and is reversible
when these diets are withdrawn. Changes in sclerosis may be another useful
indicator of the formation and reversal of lesions and may involve changes
in EDRF. Future studies of atherosclerosis reversal should use a
combination of measures to evaluate both atherosis and sclerosis.
ARTICLES
Reversal of atherosis and sclerosis. The two components of atherosclerosis
Atherosclerosis Research Institute, University of Southern California, School of Medicine, Los Angeles 90024.
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