Atherosclerosis is the buildup of fatty deposits in artery walls, narrowing blood vessels and raising the risk of heart attack and stroke. It's widespread — about half of adults over 45 have some degree of plaque in their arteries. Treatment centers on statins, blood pressure control, and lifestyle changes, with procedures like stents or bypass surgery for severe blockages.
What's actually going on in research
Trials are testing drugs that target inflammation in artery walls, novel cholesterol-lowering agents beyond statins, therapies to stabilize or even reverse existing plaque, and ways to predict who faces the highest risk. PCSK9 inhibitors like evolocumab and alirocumab are FDA-approved and drop LDL cholesterol dramatically. Researchers are also studying the gut microbiome's role and how metabolic disease accelerates plaque formation.
Anti-inflammatory drugs
Trials are testing whether drugs that reduce artery-wall inflammation can prevent heart attacks independently of cholesterol lowering. Colchicine, an old gout drug, showed benefit in one large trial and is now used by some cardiologists.
Plaque reversal
Researchers are testing whether aggressive cholesterol lowering with newer drugs can shrink existing plaques. Imaging studies suggest some regression is possible, though whether this translates to fewer events is still being studied.
RNA-based therapies
Injections that silence genes controlling cholesterol production are in trials. Inclisiran, approved in 2021, requires dosing just twice a year and keeps LDL low for months.
What to know before you search
Eligibility typically depends on cholesterol levels, history of heart attack or stroke, presence of diabetes, and whether current medications have brought cholesterol to target.
What types of trials are currently open
- Cholesterol-lowering trials — Testing new drugs that reduce LDL cholesterol, often in people who can't tolerate statins or need deeper reduction. These include PCSK9 inhibitors, bempedoic acid, and gene-silencing therapies.
- Inflammation trials — Testing drugs that calm inflammation in artery walls, based on evidence that inflammation drives plaque rupture and heart attacks.
- Imaging studies — Using CT scans or ultrasound to measure whether treatments slow plaque growth or cause regression. These studies track artery changes over one to two years.
- Prevention trials — Testing whether drugs or lifestyle interventions prevent heart attacks and strokes in people with atherosclerosis but no prior events.
- Biomarker studies — Following people with atherosclerosis to identify blood tests or imaging findings that predict future heart attacks, aiming to guide treatment intensity.
Recently added Atherosclerosis trials
Vascular Inflammation in Atherosclerosis - Whole Body Molecular PET/CT Imaging Using Folate Receptor β
This study investigates inflammation in the blood vessels of people with coronary artery disease (CAD) or a recent myocardial infarction. Inflammation plays an important role in the development and progression of atherosclerosis, but there is currently no established clinical imaging method for detecting inflammation in atherosclerotic plaques throughout the body. The study uses a new PET imaging tracer called 18F-AlF-NOTA-Folate. The tracer is designed to bind to folate receptor beta (FR-β), a marker found on activated macrophages, which are immune cells involved in inflammation. The aim is to determine whether PET imaging with this tracer can detect and measure inflammation in atherosclerotic plaques. Approximately 90 patients will participate. One group will include patients with suspected or stable coronary artery disease who are undergoing coronary CT angiography and PET imaging as part of their clinical assessment. A second, smaller group will include patients who have recently had a myocardial infarction. Participants will undergo PET and CT imaging and provide blood samples. The imaging will examine the coronary arteries and other major arteries, including the carotid arteries, aorta and iliac arteries. The study will also investigate blood flow in the heart and other organs and examine the relationship between vascular inflammation, atherosclerotic plaque characteristics and markers of inflammation in the blood. The study is not testing a treatment for coronary artery disease. The folate tracer is administered only for imaging purposes. Participants will be followed through hospital and registry records for up to five years to investigate whether imaging findings are associated with later cardiovascular events. The study may provide new information about how inflammation is distributed in atherosclerosis and whether FR-β-targeted PET imaging could be useful for detecting and studying vascular inflammation in patients with cardiovascular disease.
Receive imaging scans of your arteries during a heart procedure
This prospective, single-center, exploratory study will evaluate the association between atherosclerotic and lipid plaque burden in the internal pudendal arteries, assessed by intravascular ultrasound and near-infrared spectroscopy (IVUS-NIRS), and the severity of erectile dysfunction in adult men with documented or suspected coronary artery disease undergoing clinically indicated coronary angiography. After completion of the clinically indicated coronary procedure, eligible and hemodynamically stable participants with favorable pelvic vascular anatomy will undergo selective pudendal angiography and investigational IVUS-NIRS imaging of one or both internal pudendal arteries. Erectile function will subsequently be assessed within 30 days using the 5-item International Index of Erectile Function (IIEF-5). The primary outcome will be the correlation between pudendal maxLCBI4mm and IIEF-5 score. Secondary analyses will characterize pudendal and coronary plaque burden, assess the relationship between pudendal and coronary lipid burden, evaluate associations with cardiovascular risk factors, and describe the technical feasibility and safety of pudendal IVUS-NIRS imaging.
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