Coronary atherosclerosis reduced in patients with familial hypercholesterolemia after intensive cholesterol lowering with low-density lipoprotein-apheresis: 1-year follow-up study. The Osaka LDL-Apheresis Multicenter Trial Group.
To test the hypothesis that aggressive cholesterol lowering results in a rapid regression of coronary atherosclerosis, the effect of low-density lipoprotein (LDL)-apheresis for 1 year on coronary artery diameters was studied in patients with heterozygous familial hypercholesterolemia. LDL-apheresis was performed every 2 weeks in 13 patients with LDL-cholesterol levels > or = 200 mg/dL despite treatment with conventional dietary and drug therapies. Coronary arteriography was performed before and 1 year after the initiation of treatment. The LDL-cholesterol level was decreased by an average of 71% immediately after the initial LDL-apheresis and by 30% before the second apheresis. Such phasic changes were observed throughout the trial. Computer-assisted automated quantitative arteriograms analyzed 101 proximal coronary segments. The mean lumen diameter of angiographically normal sections of each segment was slightly but significantly increased from 2.93 +/- 0.89 mm at baseline to 3.05 +/- 0.93 mm at the follow-up arteriogram (P < 0.05); 54 of the 101 segments showed a lesion stenosed by 20% or more in diameter. The minimal diameter of individual lesions was also significantly increased from 2.17 +/- 0.67 mm to 2.36 +/- 0.76 mm (P < 0.05), and thus the diameter stenosis was significantly reduced from 32.3 +/- 10.5% to 28.2 +/- 12.1% (P < 0.05). It is concluded that 1 year of aggressive cholesterol lowering, using LDL-apheresis, can significantly reduce coronary atherosclerosis in patients with familial hypercholesterolemia.
Kitabatake
A
A
Department of Cardiovascular Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
Sato
H
H
Hori
M
M
Kamada
T
T
Kubori
S
S
Hoki
N
N
Minamino
T
T
Yamada
M
M
Kato
T
T
D000328:Adult; D000790:Angiocardiography; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001781:Blood Component Removal; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000150:complications / Q000628:therapy*; D007091:Image Processing, Computer-Assisted; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged
D000924:Anticholesteremic Agents; D008077:Lipoproteins, LDL