Intima-media Thickness Measured at the Common-carotid Artery in Patients Treated with Lipoprotein Apheresis

Abstract

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Common carotid intima-thickness (CIMT) is as a marker of arterial wall injury and arteriosclerosis. Healthy asymptomatic young and middle-aged individuals of the European-ancestry show mean CIMT of 610 + /-110μmmicrometers with a strong linear relation between age and CIMT. In the general population, an annual rate of change in mean common CIMT is estimated at 15μm (95% CI, 12 to 17), with a median standard deviation of 53. <h3>Objective/Purpose</h3> We sought to compare annual CIMT progression rates in 10 patients with severe hypercholesterolemia treated with lipoprotein apheresis with published annual CIMT progression estimates in age-comparable 1) healthy individuals based on the nomograms, 2) patients with elevated lipoprotein(a), and 3) familial hypercholesterolemia (FH). <h3>Methods</h3> Patients (mean age 60+/-9 years, 70% female, 80% statin intolerant) were treated with the dextran sulfate adsorption apheresis system for primary and secondary atherosclerotic cardiovascular disease (ASCVD) prevention every two weeks between 2005 and 2020 (mean duration, 10+/-4 years). To minimize intra-individual and inter-individual variability in CIMT assessment we used computerized algorithms with measurements performed by the same sonographer. <h3>Results</h3> The baseline mean CIMT was 850+/-170μm and maximum CIMT was 1040+/-220um across the age range of 46 to 70 years. The baseline median levels of total cholesterol were 317 (interquartile range (IQR), 262 to 361); LDL-C, 214 (133 to 253); HDL-C, 56 (44 to 68); triglycerides, 170 (121 to 215), lipoprotein(a), 26 (9 to 120), all in mg/dL. 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 lipoprotein(a) levels, respectively. Regular treatment with lipoprotein apheresis resulted in average reduction in the mean CIMT of −40μm (IQR, −50 to 20). An annual CIMT progression rate was associated with the combined percentage reduction in the lipoprotein(a) (P=0.032) and LDL-C levels (P=0.029). Using the Bayesian Estimation Supersedes the t -Test (BEST) method, the annual rate of CIMT progression was compared to those reported in the literature (Table 1). <h3>Conclusions</h3> Composite CIMT progression rates were slowed with lipoprotein apheresis. In this cohort of high-risk patients with poor statin tolerance, the use of CIMT surveillance was noted to increase compliance with long-term lipid-modifying therapies in the clinical setting.