Plaque burden, plaque morphology, and HDL: can atherosclerosis imaging provide insights into the complex, multifactorial etiology of atherosclerosis progression and vulnerability?

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In response to the article by Phan et al. Association of high-density lipoprotein levels and carotid atherosclerotic plaque characteristics by magnetic resonance imaging (DOI 10.1007/s10554-006-9175-7).

In this issue of the journal Phan et al. describe the use magnetic resonance imaging (MRI) for the assessment of carotid atherosclerotic plaque characteristics and their relationship to serum levels of HDL [1]. The findings, in a subgroup of patients from the HATS trial [2], provide insights into the pathophysiology of atherosclerosis progression and its in vivo observation with imaging technology.

Atherosclerosis progression/regression and vulnerability/stability are complex, multifactorial processes, related to lipid metabolism and inflammatory changes in the vessel wall. This has been shown in multiple pathophysiologic studies [3], but also becomes obvious in the response to treatment. While LDL-C is the major focus of prevention guidelines (ATP III) [4], even the most aggressive treat