Low-density lipoprotein apheresis in the prevention of recurrent coronary heart disease: A review

Ibis article summarizes the clinical evidence for low-density lipoprotein (LDL) apheresis to improve prognosis of patients with coronary heart disease. Regarding clinical events or angiographic parameters, most trials have revealed favorable effects on coronary artery disease. In the studies with a clinical endpoint, approximately 50% reduction in incidence of major coronary events was achieved by LDL apheresis. Similarly, in the studies with a angiographic parameter, coronary atherosclerosis was suppressed or regressed by LDL apheresis. The mechanisms of these effects by LDL apheresis are attributed to improvement in coronary flow reserve, which is dependent upon increases in hemorheological factor, nitric oxide, vasoactive substances or decrease of oxidized LDL. These new insights into mechanisms will expand the indication of LDL apheresis to other pathophysiological conditions of coronary artery disease and other disorders.