The extent of intervention effects on carotid intima-media thickness (CIMT) can predict
the degree of atherosclerotic cardiovascular risk-reduction. We hypothesized that
regular lipoprotein apheresis over the course of 10 years might slow down progression
of CIMT in patients with severe hypercholesterolemia. This case series describes 10
Caucasian patients (mean age 60 ± 9 years, 70% female, 80% statin intolerant) with
a severe hypercholesterolemia phenotype treated with lipoprotein apheresis between
2005 and 2020 (mean duration, 10 ± 4 years). The median pretreatment low-density lipoprotein
cholesterol (LDL-C) level was 214 mg/100 ml (95% confidence interval, 145 to 248),
lipoprotein(a) (Lp[a]), 26 mg/100 ml (15 to 109; 40% with Lp(a)>60 mg/100 ml). Three patients were
diagnosed with a monogenic cause. The baseline mean CIMT was 850 ± 170 µm, and maximum
CIMT was 1,040 ± 220 µm across the age range of 46 to 70 years. Acute effects of lipoprotein
apheresis determined as a difference before and immediately after the procedure were
estimated as a median of 72 ± 8% and 75 ± 7% reduction in the LDL-C and Lp(a) levels,
respectively. Using the imputed trajectories, period-specific on-treatment time-weighted
averages for LDL-C and Lp(a) were 141 mg/100 ml (interquartile range, 89 to 152; 38% reduction from the baseline)
and 24 mg/100 ml (interquartile range, 12 to 119; 19% reduction from baseline), respectively.
The number of patients with CIMT above their “vascular age” decreased from 80% to
30% over the treatment course. In conclusion, an increase in CIMT seen with advanced
age and severe hypercholesterolemia was halted with lipoprotein apheresis with an
estimated annual rate of change in mean common CIMT of −4 µm/y and maximum CIMT of
−3 µm/y.
Graphical Abstract
Graphical Abstract
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Article Info
Publication History
Published online: June 16, 2022
Received in revised form:
April 11,
2022
Received:
February 27,
2022
Footnotes
Institutional Review Board Statement: Ethical review and approval was waived for this study. Treatment was provided as part of the clinical care.
Funding: None.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
