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Long term effect of LDL apheresis in Japan. LDL Apheresis Study Group
1Tokyo Teishin Hp., Japan.
Insights
LDL-apheresis effectively treats ischemic heart disease (IHD) in familial hypercholesterolemia (FH) patients. This therapy significantly lowers LDL cholesterol, improving IHD symptoms and regression of xanthomas.
Area of Science:
- Cardiology
- Metabolic Disorders
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol.
- Ischemic heart disease (IHD) is a major complication of FH.
- Long-term treatment effects of LDL-apheresis on IHD in FH patients require evaluation.
Purpose of the Study:
- To evaluate the long-term efficacy of LDL-apheresis in patients with homozygous and heterozygous FH.
- To assess the impact of LDL-apheresis on IHD, xanthomas, and other clinical parameters.
Main Methods:
- Retrospective analysis of 59 FH patients (10 homozygous, 49 heterozygous) undergoing LDL-apheresis.
- Monitoring of lipid profiles, IHD symptoms, ECG changes, and xanthoma regression.
- Coronary angiography was performed in select cases.
Main Results:
- LDL-apheresis significantly reduced LDL cholesterol levels in both homozygous (426 to 151 mg/dl) and heterozygous (271 to 126 mg/dl) FH.
- Improvement in IHD was observed in 50% of homozygous and a significant proportion of heterozygous FH patients.
- Regression of xanthomas and decreased anginal attack frequency were noted.
- Coronary angiography showed regression or no progression of stenosis in some patients.
- LDL-apheresis was effective in 25 out of 44 patients with IHD or xanthoma.
Conclusions:
- LDL-apheresis is an effective therapeutic option for managing IHD in FH patients.
- The procedure demonstrates significant lipid-lowering effects and clinical benefits, including regression of xanthomas.
- Hypotension was the main side effect observed during treatment.
Abstract:
LDL-apheresis is introduced in many cases all over Japan. Among them, evaluation of long-term effect on ischemic heart disease (IHD) has made on 10 cases with homozygous familial hypercholesterolemia (FH) and 49 cases with heterozygous FH. As to homozygous FH, 3 patients had angina pectoris. Mean duration of treatment was 26 months (52 treatments). The changes in total cholesterol (TC) in each treatment was from 426 mg/dl to 151 mg/dl. Improvement in IHD was observed in 5 out of 10 cases. As to heterozygous FH, 17 cases had history of myocardial infarction and 12 had angina pectoris. Mean duration of treatment was 13 months (19 treatments). Mean TC was decreased from 271 mg/dl to 126 mg/dl by each treatment. Regression in Achilles tendon thickenting or skin and palpebral xanthomas was observed. Frequency of anginal attacks decreased in 8 out of 17 cases. Ischemic change in ECG were improved in 3 out of 26 cases. Coronary angiography performed with 2 to 3 years of interval in some cases revealed regression or no progression in coronary stenosis. As a whole, IHD improved in 15 cases and exacerbated in 2 cases. Main side effect was hypotension attack. Bradycardia and anginal attack during treatment were observed in some cases. LDL-apheresis was judged as effective in 25 out of 44 patients with IHD or xanthoma.