Long‐term effects of LDL apheresis on carotid arterial atherosclerosis in familial hypercholesterolaemic patients

Objectives. To assess the long‐term effect of LDL apheresis on carotid arterial atherosclerosis in severe familial hypercholesterolaemic (FH) patients. Design. Changes in existing plaque, new plaque formation and annual progression rate of carotid early plaque were evaluated by B‐mode ultrasonography. Subjects. LDL apheresis group: two homozygous FH and nine heterozygous FH patients received a combination of LDL apheresis and cholesterol‐lowering drug therapy for a mean of 7.8 years. Control group: 10 heterozygous FH patients were maintained by medication only for a mean of 5.5 years. Results. As a result of LDL apheresis treatment, LDL cholesterol levels reduced from 16.0 ± 3.60 to 6.43 ± 0.07 mmol L–1 in homozygous FH patients and from 11.5 ± 2.46 to 4.32 ± 1.2 mmol L–1 in heterozygous FH patients. During the long‐term treatment period, the existing plaque tended to progress and new plaque formation in carotid arteries was also observed in both groups. The annual progression rate of mean maximum intima–media thickness in the common carotid artery was a mean of –0.0023 ± 0.0246 mm year–1 in heterozygous FH patients in the LDL apheresis group, suggesting regression. This was significantly lower when compared with the control group, which had a mean of 0.0251 ± 0.0265 mm year–1. Conclusion. The results suggest that the long‐term treatment with combined LDL apheresis and drugs may delay the progression of the atherosclerotic process and prompt the stabilization of atheromatous plaque in severe FH patients.