Long‐term effects of LDL apheresis on carotid arterial atherosclerosis in familial hypercholesterolaemic patients

Abstract

Abstract. Koga N, Kurashige Y, Sato T (Koga Hospital, Kurume, Japan). Long-term effects of LDL apheresis on carotid arterial atherosclerosis in familial hypercholesterolaemic patients. J Intern Med 246: 35]43.Objectives. To assess the long-term effect of LDL apheresis on carotid arterial atherosclerosis in severe familial hypercholesterolaemic (FH) patients. Design. Changes in existing plaque, new plaque formation and annual progression rate of carotid early plaque were evaluated by B-mode ultrasonography. Subjects. LDL apheresis group: two homozygous FH and nine heterozygous FH patients received a combination of LDL apheresis and cholesterol-lowering drug therapy for a mean of 7.8 years. Control group: 10 heterozygous FH patients were maintained by medication only for a mean of 5.5 years. Results. As a result of LDL apheresis treatment, LDL cholesterol levels reduced from 16.0 6 3.60 to 6.43 6 0.07 mmol L 21 in homozygous FH patients and from 11.5 6 2.46 to 4.32 6 1.2 mmol L 21 in heterozygous FH patients. During the long-term treatment period, the existing plaque tended to progress and new plaque formation in carotid arteries was also observed in both groups. The annual progression rate of mean maximum intima]media thickness in the common carotid artery was a mean of ]0.0023 6 0.0246 mm year 21 in heterozygous FH patients in the LDL apheresis group, suggesting regression. This was significantly lower when compared with the control group, which had a mean of 0.0251 6 0.0265 mm year 21 . Conclusion. The results suggest that the long-term treatment with combined LDL apheresis and drugs may delay the progression of the atherosclerotic process and prompt the stabilization of atheromatous plaque in severe FH patients.

Homozygous familial hypercholesterolemia: Long term clinical course and plasma exchange therapy for two individual patients and review of the literature

“…Cerebral disease plays a minor role in the morbidity in HFH reported in the literature and as shown above, despite the severe carotid stenosis in our patients, none had cerebral symptoms. Whether this means different clinical manifestations between the coronary and cerebral circulation exist, implicating that a less invasive approach toward cerebral atherosclerosis is warranted requires further investigation as LDL apheresis has shown to retard progression of intima-medial thickness [14].…”

Role of Lipoprotein Apheresis in Cardiovascular Disease Risk Reduction

“…In 1999, Koga et al [136] published a study examining the long-term effect of LA on carotid artery atherosclerosis. Eleven FH patients received LA for an average of 7.8 years, while 10 control FH patients received medication only for an average of 5.5 years.…”

Low-density lipoprotein apheresis as a treatment option for hyperlipidemia

“…In a study of seven patients with heterozygous FH, HELP apheresis reduced total and LDL cholesterol and fi brinogen levels, and led to a signifi cant reduction in carotid plaque volume [29]. An additional study suggesting a benefi t from LDL apheresis demonstrated carotid plaque regression compared with the control group in two patients with homozygous FH and nine with heterozygous FH [30]. The benefi t of LDL apheresis also was demonstrated in a study of peripheral arterial disease examining the effects of LDL apheresis on aortotibial stenosis and carotid intima-media thickness.…”