Imaging and peroxisome proliferator-activated receptor agonists: uncovering their role in atherosclerosis development.

Technologic advances have enhanced clinical understanding of the physical changes that occur in the vasculature during atherosclerosis development. Traditionally, diagnostic techniques such as angiography have focused on the lumen of the coronary arteries, with narrowing of the lumen suggesting the presence of atherosclerotic plaques in the vessel wall. Newer methods, such as intravascular ultrasound, focus on the vessel wall itself and have shown that extensive plaque development can occur in conjunction with minimal luminal restriction of the artery. In fact, lumen narrowing occurs only in the very late stages of atherosclerosis, suggesting that, in many cases, the early stages of disease development would remain undetected when angiographic techniques are used. The ability to detect atheromatous disease, particularly in the early stages of development, must be accompanied by systemic pharmacologic therapies effective in inducing atherosclerotic regression. With this in mind, a recent study in patients treated with statins has shown less progression with aggressive lipid lowering, while the findings from trials employing peroxisome proliferator-activated receptor-gamma agonists are eagerly awaited.