Long-Term Effects of LDL Apheresis on Coronary and Carotid Atherosclerosis in Familial Hypercholesterolemic Patients(Symposium 7: LDL and Lp(a) Apheresis)

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To assess the long term effect of LDL apheresis, we investigated the angiographic changes in coronary atherosclerosis, the B-mode ultra-sonographic changes in the plaque of carotid arteries and the annual progression rate of early atherosclerosis of the common carotid artery. We studied 11 patients with severe familial hypercholesterolemia, two with homozygous FH and nine with severe heterozygous FH who received combined LDL-apheresis and drug therapy for a mean of 7.7 years. During the treatment period, the mean time-averaged level of LDL cholesterol was 181 ± 52 mg/dl. From the coronary angiographic results, three patients showed regression, six patients showed progression and two patients showed no change. Cardiac events occurred in six patients.However, the annual progression rate of mean maximum intima-media thickness in the common carotid artery was a mean of 0.0002 mm/year in the LDL-apheresis group (combined LDL apheresis and drug therapy group), which was significantly lower in comparison with the mean of 0.0309 mm/year seen in the control group (drug therapy only group). In the heterozygous FH patients (nine patients), the annual progression rate was lowered to -0.0023 mm/year, suggesting regression. These findings confirmed that long-term treatment with LDL apheresis may contribute to delaying the progression of the atherosclerotic process and prevent the rupture of atheromatous plaque.
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