title: A case of familial hypercholesterolemia; secession from LDL-apheresis by the drug treatment with potent statin and resin.
abstract: Low density lipoprotein (LDL)-apheresis is a useful tool for the treatment of familial hypercholesterolemia (FH) with coronary artery disease (CAD). However, it gives economic, physical and mental burdens for the patients. We reports a case of FH in whom LDL-apheresis treatment was seceded with drug treatment with a potent statin and bile acid-sequestering resin. A 54-year-old woman was admitted for evaluation of atherosclerotic lesion after 4 years of LDL-apheresis and 1 year of drug medication with a potent statin, atorvastatin and resin, cholestimide with coronary angiography. She had been diagnosed as heterozygous FH when she was 46 years old. Oral medication was initiated at the outpatient clinic. LDL-cholesterol (C) level was not successfully controlled despite the administration of a statin, pravastatin, a fibrate, clinofibrate and probucol at maximum doses Concomitantly. Therefore, as combination therapy, LDL-apheresis was introduced in May 1997. However, the patient strongly complained of the economic, physical, and mental burdens of LDL-apheresis and requested discontinuation of apheresis. Therefore, LDL-apheresis was discontinued in July 2000, and oral medication was subsequently changed to a combination of atorvastatin and cholestimide, resulting in successful control of serum LDL-C level by oral medication alone. We compared coronary arteriographic findings between 1997 and 2001. No advancement of lesions was observed. We think that strong drug treatment can secede from the LDL-apheresis for treatment of patients with FH.
authors.affiliation: Department of Cardiology, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan. shiina@is.icc.u-tokai.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shiina
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Homma
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Oguma
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fusegawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Ozawa
authors.forename: Shunnosuke
authors.initials: S
authors.lastname: Handa
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Tanabe
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000175:diagnosis / Q000473:pathology; D000069059:Atorvastatin; D001781:Blood Component Removal / Q000191:economics / Q000523:psychology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000235:genetics / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008077:Lipoproteins, LDL / Q000097:blood*; D008875:Middle Aged; D010375:Pedigree; D011758:Pyrroles / Q000627:therapeutic use*; D011859:Radiography; D014973:Xanthomatosis / Q000473:pathology
chemical_list: D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D008077:Lipoproteins, LDL; D011758:Pyrroles; D000069059:Atorvastatin