Long-term efficacy of low density lipoprotein apheresis on coronary heart disease in familial hypercholesterolemia

Familial hypercholesterolemia (FH) is characterized by severe hypercholeste rolemia and premature coronary heart disease (CHD). The lower the plasma ch olesterol level, the more likely it is that CHD can be prevented or retarde d; aggressive cholesterol-lowering therapies may be indicated for FH patien ts with CHD. This study describes the long-term (6 years) safety and effica cy of intensive cholesterol-lowering therapies with low-density lipoprotein (LDL) apheresis in heterozygous FH patients with CHD. One hundred thirty h eterozygous FH patients with CHD documented by coronary angiography had bee n treated by cholesterol-lowering drug therapy alone (n = 87) or LDL aphere sis combined with cholesterol-lowering drugs (n = 43). Serum lipid levels a nd outcomes in each treatment group were compared after approximately 6 yea rs. Both treatment groups had significant reductions in serum cholesterol, LDL cholesterol, and high density lipoprotein cholesterol levels. LDL apher esis significantly reduced LDL cholesterol levels from 7.42 +/- 1.73 to 3.1 3 +/- 0.80 mmol/L (58%) compared with group taking drug therapy, from 6.03 +/- 1.32 to 4.32 +/- 1.53 mmol/L (28%). With Kaplan-Meier analyses of the c oronary events including nonfatal myocardial infarction, percutaneous trans luminal coronary angioplasty, coronary artery bypass grafting, and death fr om CHD, the rate of total coronary events was 72% lower in the LDL-apheresi s group (10%) than in drug therapy group (36%) (p = 0.0088). It is conclude d that LDL-apheresis is effective as treatment of CHD in FH heterozygotes, and may become the therapy of choice in severe types of FH. (C) 1998 by Exc erpta Medico, Inc.