Effects of intensive lipid lowering by low-density lipoprotein apheresis on regression of coronary atherosclerosis in patients with familial hypercholesterolemia: Japan Low-density Lipoprotein Apheresis Coronary Atherosclerosis Prospective Study (L-CAPS)

Twenty-five heterozygous familial hypercholesterolemic patients treated wit h LDL-apheresis and drugs and 11 patients treated with drugs underwent foll ow-up angiography 2.3 years later. One-hundred thirteen lesions were measur ed by quantitative angiography. Mean LDL-cholesterol levels during the tria l were 140 +/- 34 mg/dl in the apheresis group and 170 +/- 58 mg/dl (P < 0. 05) in the control group. The mean changes in minimal lumen diameter of les ions were +0.19 +/- 0.30 mm (improved) in the apheresis group (n = 76) and -0.44 +/- 0.40 mm (worsened) in the control group (n = 37) (P < 0.0001). Wh en progression and regression were defined as a change in minimal lumen dia meter of +/-0.67 mm, in the apheresis group, two (8%) patients had progress ion, 19 (76%) stayed unchanged and four (16%) had regression, but in the co ntrol group seven (64%) patients had progression and four (36%) stayed unch anged. The frequency of regression or no change was significantly higher in the apheresis group than in the control group (P < 0.004). Intensive chole sterol lowering therapy with LDL-apheresis and lipid lowering drugs can ach ieve a substantial decrease in LDL-cholesterol levels to induce regression of coronary lesions in familial hypercholesterolemic patients with advanced coronary artery disease. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.