The objective was to determine whether more aggressive LDL cholesterol lowering, with biweekly LDL-apheresis plus the HMG-CoA reductase inhibitor simvastatin, more effectively exerts an antiatherosclerotic effect than lipid lowering to more conventional cholesterol levels with simvastatin alone. The LDL-Apheresis Atherosclerosis Regression Study (LAARS) was designed as a prospective, open, randomized, single-center study in men with primary hypercholesterolemia and extensive CAD. 26 Given the relatively small changes in the severity of lesions demonstrated in angiographic trials and the unclear clinical benefits of such changes, the addition of measurements to predict the functional significance of changes in coronary stenosis seems important. 23 24 25 Despite certain limitations, QCA is one of the most precise procedures available for assessing progression or regression of CAD. The quantitative computerized analysis of the extent of atherosclerosis on QCA has been developed and extensively evaluated for angiographic trials. The application of this method may offer opportunities in the prevention of progression or even inducing regression of coronary atherosclerosis in selected patients with primary hyperlipidemia and established CAD. 17 18 The performance of regular apheresis permits the achievement of lower levels of LDL cholesterol, which is not usually possible to attain with drug therapy alone. 16Ĭontinuous LDL-apheresis, using dextran sulfate cellulose columns, selectively removes apolipoprotein B–containing lipoproteins from plasma. 13 Until recently, intensive lipid lowering in men with established CAD using HMG-CoA reductase inhibitors was the most effective means in terms of slowing or arrest of progression of coronary atherosclerosis 14 15 and consequently reducing the number of clinical events. 4 5 6 7 8 9 10 11 12 The common denominator of these trials is reduction of LDL cholesterol. 3 Regression of coronary atherosclerosis is demonstrated to a limited extent in some patients in most of these trials. 1 2 Primary and secondary prevention trials, predominantly conducted in men with hypercholesterolemia, have shown that lipid lowering regimens result in less progression of angiographic lesions. The relation between total cholesterol and LDL cholesterol levels and the incidence of CAD is well established. However, more aggressive treatment induced functional improvement, which may precede anatomic changes. On bicycle exercise tests, the time to 0.1 mV ST-segment depression increased significantly by 39% and the maximum level of ST depression decreased significantly by 0.07 mV in the apheresis group versus no changes in the medication group.Ĭonclusions Two years of lipid lowering both with medication alone or LDL-apheresis with medication showed angiographic arrest of the progression of coronary artery disease. On the basis of coronary segment, mean percent stenosis of all lesions showed a tendency to decrease only in the apheresis group more minor lesions disappeared in comparison to the medication group. No differences between the apheresis and medication groups were found in mean segment diameter (−0.01☐.16 mm versus 0.03☐.16 mm, respectively) or in minimal obstruction diameter (−0.01☐.13 mm versus 0.01☐.11 mm, respectively), expressed as means per patient. Primary quantitative coronary angiographic end points were changes in average mean segment diameter and minimal obstruction diameter. The mean reduction in LDL cholesterol was 63% (to 3.0 mmol L −1 in the apheresis and medication groups, respectively.Baseline (mean±SD) LDL cholesterol was 7.8☑.9 mmol In both groups a dose of simvastatin of 40 mg per day was administered. Methods and Results For 2 years, 42 men were treated with either biweekly LDL-apheresis plus medication or medication alone. To assess the effect of more aggressive lipid lowering with LDL-apheresis, we set up a randomized study in men with hypercholesterolemia and severe coronary atherosclerosis. LDL-apheresis has the potential to decrease LDL cholesterol to very low levels. Customer Service and Ordering Informationīackground Intensive lipid lowering may retard the progression of coronary atherosclerosis.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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