Abstract Over the past two decades, studies with serial coronary imaging have consistently shown favorable changes in plaque phenotype in response to lipid-lowering therapy (LLT). Here, we review these studies, which had varied follow-up periods, to examine the time course of changes in plaque phenotype. The plaque response to LLT appears to start with the thickening of the fibrous cap, followed by a decrease in lipid components and ultimately a regression in plaque volume.