Abstract 17457: Selective, Extra-Corporal LDL-C Apheresis Markedly Reduces Atherosclerotic Vessel-Wall Inflammation in High-Risk Patients
Background: Low-density lipoprotein cholesterol (LDL-C) plays a pivotal role in the pathogenesis of cardiovascular disease. Inflammation has been accepted as a partly independent contributor in the development of complicated plaques and ensuing clinical events. The exact relation between LDL-cholesterol and vessel wall inflammation is less well characterized.
Methods: We selec0ted patients with familial hypercholesterolemia (FH) characterized by profoundly elevated LDL-cholesterol (LDL-C) levels, who could not be treated with statins due to statin-intolerance. In these patients, we performed weekly LDL-apheresis using a selective LDL-C removal column (DALI) during a period of 8 weeks. As control groups we selected age and sex-matched healthy individuals with normal LDL-C, as well as high-risk patients with intermediately elevated LDL-C. In all patients vascular inflammation (target-to-background-ratio (TBR) by 18F-fluorodeoxyglucose (FDG)-positron emission topography (PET) in the ascending aorta and carotids were assessed. TBR measurements were repeated in FH-patients after 8 weeks of LDL-apheresis.
Results: Inflammatory activity (TBRmax) of the aorta in FH-patients as well as in high-risk patients with increased LDL-C levels was significantly higher compared to TBRmax in healthy control subjects (p<0.001 and p<0.05, FH patients vs controls and high-risk patients vs controls, respectively). Following 8-weeks of selective LDL-C apheresis treatment, mean LDL-C levels were reduced by 54% (P<0.001). TBRmax of the ascending aorta was decreased by 18.4% (SD 14.1), whereas the TBRmax of the carotids was decreased by 10.9% (SD 9.0)(both p<0.05).
Conclusions: Potent, selective LDL-C lowering by extra-corporeal LDL-C apheresis profoundly reduces the increased inflammatory activity of the atherosclerotic vessel-wall in patients with elevated LDL-C levels and overt atherosclerosis. These data lend proof for a direct, causal role of LDL-C in eliciting vascular inflammation, implying that potent LDL-C lowering strategies have the potential to reduce vessel-wall inflammation in patients with overt atherosclerosis.
- © 2012 by American Heart Association, Inc.