¿Son necesarios los estudios angiográficos para valorar la eficacia terapéutica del tratamiento hipolipemiante?

Coronary angiography has been the standard technique to evaluate coronary disease and its changes with treatment. This technique can visualize the coronary lumen and stenosis but not the arterial wall. Other limitations are that it is an aggressive and expensive procedure and its use is restricted to patients with established coronary disease. New imaging techniques for the protection of preclinical atherosclerosis (carotid ultrasonography, computed tomography for the detection of coronary calcium and vascular magnetic resonance imaging) allow atherosclerotic load and its changes with treatment to be evaluated noninvasively in individuals with or without coronary disease. Another recent technique, intravascular ultrasonography, is also aggressive, but is useful because it evaluates both the lumen and the arterial wall. Although still not standardized, ultrasonographic measurement of carotid intima-media thickness is the most accessible technique and is the only procedure recommended for studies of atherosclerosis regression. Various clinical studies have demonstrated that progression of carotid atherosclerosis is halted or that there is regression after 1-4 years of treatment with statins. Angiographic studies to evaluate the therapeutic efficacy of lipid lowering drugs are not really required.