[New treatment strategies in coronary disease].

The mortality associated with coronary atherosclerosis has decreased by 30% to 40% in the last few decades. This reduction has followed major pharmacological and biotechnological advances and can possibly be attributed to better management of risk factors for coronary atherosclerosis and to more effective therapy of its late manifestations. Nevertheless, the coronary artery disease remains a major public health problem. It is responsible for 40% to 45% of deaths in our population and, although it becomes manifest later than previously, its incidence and prevalence may not have declined significantly. Recent studies suggest that progression of coronary atherosclerosis can be delayed, that regression can also occur, and that this can lead to a reduction in morbidity and mortality. Several types of interventions have been performed in these studies. Some of them such as a drastic modification in lifestyle, the administration of one or several hypocholesterolemic agents or partial ileal bypass have achieved these results by markedly lowering LDL or raising HDL cholesterol. Other manipulations of plasma lipoproteins are also possible, such as the administration of specific protein or enzyme inhibitors, anti-oxidants and omega-3 fatty acids. Calcium antagonists and possibly angiotensin converting-enzyme inhibitors slow the progression of early coronary lesions and prevent the appearance of new lesions. These interventions, in addition to influencing the size of the atherosclerotic plaque, can have other important effects. They can contribute to the preservation of integrity and function of endothelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)