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Intravascular ultrasound (IVUS) has emerged as a powerful imaging modality for the assessment of the arterial wall and it's response to the accumulation of atherosclerotic plaque. The ability to image the coronary arteries on a serial basis provides a unique opportunity for IVUS to monitor the impact that potential anti-atherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging as the primary endpoint have demonstrated that therapeutic strategies that modify LDL, HDL and blood pressure in patients with established coronary artery disease can have a profound impact on the progression of atherosclerotic plaque. This heralds a paradigm shift that emphasizes plaque regression as a potential target in the development of preventive strategies.