Regression of coronary atherosclerosis by combined LDL-apheresis and lipid-lowering drug therapy in patients with familial hypercholesterolemia: a multicenter study

Tatamia, R.; Inoue, Naonori; Itoh, Hiroshi; Kishino, B; Koga, Nobuhiko; Nakashima, Yasuhide; Nishide, Toshio; Okamura, Katsuaki; Saitō, Yasushi; Teramoto, Tamio; Yasugi, Tadao; Yamamoto, Akira; Goto, Yu‐ichi; Investigators, Lars

doi:10.1016/0021-9150(92)90170-l

Cited by 146 publications

(63 citation statements)

References 19 publications

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“…Many reports have demonstrated the efficacy of the procedure as a means of preventing progression and even of inducing a regression of atherosclerotic lesions in these patients [30][31][32][33][34] .…”

Section: Discussionmentioning

confidence: 99%

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Ramunni¹,

Ranieri²,

Giancipoli³

et al. 2006

Blood Purif

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Endothelial dysfunction of the optic microcirculation is considered to be the main pathogenetic mechanism in nonarteritic ischemic optic neuropathy. The aim of the present work was to assess whether a clinical improvement is correlated with a reduction in the endothelial activation markers by means of LDL apheresis (LDLA). Three weekly sessions of LDLA were administered in 23 patients affected by nonarteritic ischemic optic neuropathy. Statistically significant reductions were achieved in all parameters: total cholesterol (44.6%), LDL cholesterol (54.6%), fibrinogen (60.9%), von Willebrand factor (38.6%), sE-Selectin (22.6%), sICAM-1 (14%) and sVCAM-1 (15.5%), each of which was correlated with an improvement in the mean deviation of the visual field, although statistical significance for the single parameters was not reached. However, analysis of variance between the mean deviation improvement and the set of parameters taken together yielded highly significant results (p < 0.0001). LDLA was effective in reducing the values of all evaluated endothelial activation markers, and this trend was correlated with an improvement in the visual field.

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Section: Discussionmentioning

confidence: 99%

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Ramunni¹,

Ranieri²,

Giancipoli³

et al. 2006

Blood Purif

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“…In the LDL Apheresis Regression Study (LARS) (23), angiographic evidence for regression of CAD was observed in 10 of 32 Japanese FH patients (25 heterozygotes, 7 homozygotes) treated with LDL apheresis and lipid-lowering drugs for at least one year. None of the homozygotes showed progression and 4/7 showed regression.…”

Section: Benefits Of Ldl Apheresismentioning

confidence: 99%

LDL Apheresis: An Effective and Safe Treatment for Refractory Hypercholesterolemia

Hudgins

Gordon

Parker

et al. 2002

Cardiovascular Drug Reviews

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Through the efforts of Edward H. Ahrens, LDL apheresis became available for the treatment of patients, often with familial hypercholesterolemia, who have no alternative therapy for severely elevated LDL cholesterol levels. In the U.S., the FDA has approved this treatment for individuals on maximum diet and drugs with an LDL cholesterol greater than 300 mg/dL or greater than 200 mg/dL with coronary artery disease. Unlike plasmapheresis, apolipoprotein B-containing lipoproteins (LDL, Lp(a), and VLDL) are selectively removed by heparin precipitation or columns containing dextran sulfate cellulose or antibodies to apolipoprotein B. The acute lowering of LDL-cholesterol by a typical 2 -3 h treatment is up to 80%, and the time-averaged lowering in the 1 to 2 week interval between treatments is up to 50%, with very few side effects. The lowering of LDL-cholesterol and other cardioprotective effects of LDL apheresis have reduced chest pain, prevented new disability and prolonged life. Whole blood compatible columns in development offer the possibility of simpler and less expensive treatments.

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“…Currently, intensive lipid-lowering therapy with extracorporeal elimination of serum LDL cholesterol (LDL-apheresis) is applied to FH patients. LDL apheresis is suggested to reduce coronary atherosclerosis, [1][2][3][4][5][6] and also to improve regional myocardial perfusion, exercise tolerance, and ischemic symptoms. 4) These effects result from an improvement in endothelial nitric oxide (NO) production, [7][8][9][10] endothelial adhesiveness, 11,12) and blood rheology.…”

mentioning

confidence: 99%

Ten-year Follow-up of Familial Hypercholesterolemia Patients After Intensive Cholesterol-lowering Therapy

Masaki

Tatami²,

Kumamoto³

et al. 2005

Int. Heart J.

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SUMMARYTo prevent coronary artery disease, it is necessary for patients with familial hypercholesterolemia (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 infarction 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. (Int Heart J 2005; 46: 833-843)

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Regression of coronary atherosclerosis by combined LDL-apheresis and lipid-lowering drug therapy in patients with familial hypercholesterolemia: a multicenter study

Cited by 146 publications

References 19 publications

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

LDL Apheresis: An Effective and Safe Treatment for Refractory Hypercholesterolemia

Ten-year Follow-up of Familial Hypercholesterolemia Patients After Intensive Cholesterol-lowering Therapy

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