Ezetimibe Completely Replaced LDL-Apheresis for the Treatment of Familial Hypercholesterolemia and Coronary Artery Disease after CABG—A Case Report

Ikuo Yokoyama

doi:10.4236/jbise.2013.62a028

Abstract

Intensive treatment of hyperlipidemia is an important factor in the prevention of cardiovascular disease. Among several therapies, statins are well recognized as playing a central role, although low density lipoprotein bound cholesterol-apheresis can be used to treat very severe cases of familial hypercholesterolemia. However, statins are not always effective on their own and, recently, ezetimibe has emerged as a unique anti- hypercholesterolemic drug that acts as a cholesterol transporter inhibitor; its role is only partially understood. I experienced rare case that appeared to benefit from ezetimibe therapy, and report them as they help increase our knowledge of this novel drug.

Highlights

The effectiveness of anti-hyperlidemia therapy for preventing cardiovascular events [1,2,3,4,5] and inducing the regression of coronary artery stenosis [6] has been demonstrated
Levels of total cholesterol (TC), cLDL, and TG returned very quickly to those recorded at baseline one week after lipoprotein bound cholesterol (LDL)-apheresis
Replacing LDL-apheresis with ezetimibe notably decreased TC and cLDL to the levels that are required for the secondary prevention of coronary artery disease (CAD) after coronary artery bypass graft (CABG); this was not achieved with LDL-apheresis and statins

Summary

INTRODUCTION

The effectiveness of anti-hyperlidemia therapy for preventing cardiovascular events [1,2,3,4,5] and inducing the regression of coronary artery stenosis [6] has been demonstrated. Despite the fact that statins are currently the mainstay of dyslipidemia management, their efficacy in preventing a cardiovascular event has limitations. This is because statins may exert adverse effects by restoring cholesterol levels via an enhancement of the reuptake of cholesterol and/or altered cholesterol derived from small intestines. Combination therapy of ezetimibe and statins has been shown to be highly effective in the treatment of hypercholesterolemia [9]. I experienced a rare case in which ezetimibe appeared to have an effective role, in place of LDL-apheresis, in a patient with familial hypercholesterolemia (FH) and CAD who had undergone a coronary artery bypass graft (CABG).

OPEN ACCESS

DISCUSSION

This case provides strong evidence that replacing