Aggressive lipid lowering treatment in coronary atherosclerosis

Reduction of cholesterol by potent drugs in clinically symptomatic or asymptomatic patients with elevated cholesterol levels will substantially decrease the risk of coronary events. In selected cases more aggressive treatment of hyperlipidemia is necessary, such as in patients, homozygous for familial hypercholesterolemia, or subjects with severe coronary artery disease who are refractory to diet and drugs. LDL-apheresis, by which atherogenic lipoprotein particles are removed from the blood extracorporeally, is a therapeutic option in these cases. In this report a study is summarized, in which the effect of intervention with LDL-apheresis plus simvastatin was compared with conventional drug treatment alone in a group of patients with severe coronary artery disease with respect to changes in coronary atherosclerotic lesions and their functional impact.