Coronary atherosclerosis can regress under defined conditions. Serial intravascular ultrasound (IVUS) and coronary computed tomography angiography (CCTA) studies show that intensive low-density lipoprotein cholesterol (LDL-C) reduction via high-intensity statins, PCSK9 inhibitors, and, in selected settings, icosapent ethyl, can shrink plaque volume. Paradoxically, the arterial lumen often remains unchanged or may even narrow due to reverse or constrictive remodeling. Complementary lifestyle trials such as the Ornish study demonstrated angiographic regression driven primarily by improved endothelial and vasomotor function.
