Evaluating efficacy of pharmaceutical interventions in atherosclerosis: Role of magnetic resonance imaging and positron emission tomography

The rate of acute complications of atherosclerosis (acute myocardial infarction, ischemic stroke) has continuously decreased over the last 20 years in Western countries. This is largely explained by improvements in the reduction and treatment of cardiovascular risk factors and by the increasing number of patients who benefit from preventive treatments such as antiplatelet, lipid-lowering, or antihypertensive drugs. This means also that, when testing new drugs aimed at either halting or even reversing the progression of atherosclerotic plaques, a large number of patients will need to be included in clinical trials to demonstrate an improvement in patient outcome with the drugs. Pharmaceutical companies are therefore looking for early surrogate markers that could be evaluated in a small number of patients to predict the beneficial effects of new drugs on atherosclerotic plaques before moving to costly clinical trials with a large number of patients. In this review, we will discuss the place of atherosclerotic plaque imaging with magnetic resonance imaging and positron emission tomography for the evaluation of new antiatherosclerotic drugs.