The LDL-Apheresis Atherosclerosis Regression Study (LAARS)(Symposium 7: LDL and Lp(a) Apheresis)

概要

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The effect of more aggressive lipid-lowering on coronary and peripheral atherosclerosis and myocardial blood flow was assessed in an open, two-year study on men with hypercholesterolemia and severe coronary artery disease (CAD). Forty-two subjects were randomized to biweekly LDL-apheresis plus simvastatin or simvastatin treatment alone. Primary outcome measurements were changes in CAD, as measured by quantitative coronary angiography, and the angiographic assessment of the regional myocardial blood flow. Secondary outcome measurements were changes in peripheral vascular disease (PVD) as measured by ultrasonographic techniques. Both treatments induced complete angiographic arrest of progression of CAD. However, aggressive lipid-loweringreduced the exercise-induced ischemic threshold on the ECG and improved regional myocardial perfusion. Moreover, LDL-apheresis plus simvastatin treatment regressed carotid artery intima-media thickness and reduced the number of sides with hemodynamically significant PVD. It was concluded that more aggressive lipidlowering induces functional improvements preceding anatomical changes, probably by restoring endothelial relaxation. The impact of lipid-lowering shows variation among the different vascular beds.
日本アフェレシス学会の論文