For a study, researchers sought to anticipate that regular lipoprotein apheresis administered over 10 years could decrease the evolution of carotid intima-media thickness (CIMT) in patients with severe hypercholesterolemia. The case series presented 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% CI, 145 to 248), while the median pretreatment lipoprotein(a) (Lp[a]) level was 26 mg/100 ml (15 to 109; 40% with Lp(a)>60 mg/100 ml). In total 3 patients have been identified as having a monogenic cause. The mean CIMT at baseline was between 850 ± 170 µm, while the maximum CIMT over the age range of 46 to 70 years was between 1,040 ± 220 µm. LDL-C and Lp(a) levels were reduced by a median of between 72 ± 8% and between 75% ± 7%, respectively, as a result of lipoprotein apheresis, as measured by the difference between values before and immediately after the treatment. Using imputed trajectories, the period-specific on-treatment time-weighted averages for LDL-C and Lp(a) were 141 mg/100 ml (interquartile range, 89 to 152; 38% decrease from baseline) and 24 mg/100 ml (interquartile range, 12 to 119; 19% decrease from baseline), respectively. The percentage of individuals with CIMT older than their “vascular age” reduced from 80% to 30% throughout treatment. With an estimated yearly rate of change in mean common CIMT of −4 µm/y and maximum CIMT of −3 µm/y, lipoprotein apheresis prevented the enhancement in CIMT linked with advanced age and severe hypercholesterolemia.

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