Ten-year Follow-up of Familial Hypercholesterolemia Patients After Intensive Cholesterol-lowering Therapy
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概要
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To prevent coronary artery disease, it is necessary for patients with familial hyper-cholesterolemia (FH) to maintain a low cholesterol level. Recently a combination therapy of low-density lipoprotein (LDL) apheresis and statins has been used for FH patients, but their long-term prognosis over 10 years is unknown. In this single center prospective report, 18 FH patients with severe coronary stenosis received LDL apheresis every 2 or 4 weeks and statin therapy for 9.8 ± 3.0 years. Probucol was given to 17 of the 18 patients. We observed their clinical events as well as coronary stenosis findings and ejection fractions for 10.7 ± 2.6 years. Total and LDL cholesterol levels before therapy were 345 ± 46 and 277 ± 48 mg/dL, respectively. Immediately following LDL-apheresis, these levels decreased to 104 ± 7.5 and 66 ± 16 mg/dL, respectively. There were no cardiac deaths and 4 patients were free from any coronary events. There was one noncardiac death. Nonfatal myocardial in-farction occurred in 2 patients and coronary bypass surgery was required in one patient. Twelve patients received additional coronary angioplasty. There was little change in coronary stenosis and ejection fraction following 10 years of the combination therapy. Univariate Cox regression analysis revealed that the calculated mean LDL cholesterol level was the predictive value of treatment efficacy (mean LDL cholesterol < 140 mg/dL, hazard ratio 0.23, P = 0.028). The combination therapy of LDL-apheresis and antilipid drugs delayed the progression of coronary atherosclerosis and prevented a major cardiac event, although complete inhibition was limited to a small group. Additional coronary angioplasty is likely to be required for a favorable clinical outcome in FH patients.
- International Heart Journal刊行会の論文
著者
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Yoshimoto Nobuo
Third Department of Internal Medicine
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Masaki Nobuyuki
Third Department of Internal Medicine, Saitama Medical University Medical Center
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Shimada Yoshifumi
Department of Cardiology, Fukui Cardiovascular Center
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Tatami Ryozo
Department Of Cardiology Maizuru Kyosai Hopital
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Kumamoto Teruhiko
Department Of Cardiovascular Medicine Cardiovascular Center Fukui Kosei Hospital
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Izawa Akira
Department Of Cardiology Kanazawa Cardiovascular Hospital
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Ishise Shozo
Department Of Cardiology Maizuru Kyosai Hopital
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Katsushika Shuichi
First Department of Internal Medicine, Self-Defense Force Central Hospital
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Takamatsu Takeshi
Department of Cardiology, Maizuru Kyosai Hospital
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Maruyama Yoshiyuki
Third Department of Internal Medicine, Saitama Medical Center, Saitama Medical School
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Masaki Nobuyuki
Third Department of Internal Medicine, Saitama Medical Center, Saitama Medical School
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Izawa Akira
Department of Cardiology, Maizuru Kyosai Hospital
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Kumamoto Teruhiko
Department of Cardiology, Maizuru Kyosai Hospital
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