Nonpharmacological lipoprotein apheresis reduces arterial inflammation in familial hypercholesterolemia

Diederik F. Van Wijk, Barbara Sjouke, Amparo Figueroa, Hamed Emami, Fleur M. Van Der Valk, Megan H. Macnabb, Linda C. Hemphill, Dominik M. Schulte, Marion G. Koopman, Mark E. Lobatto, Hein J. Verberne, Zahi A. Fayad, John J.P. Kastelein, Willem J.M. Mulder, G. Kees Hovingh, Ahmed Tawakol, Erik S.G. Stroes

Research output: Contribution to journalArticlepeer-review

87 Scopus citations


Background Patients with familial hypercholesterolemia (FH) are characterized by elevated atherogenic lipoprotein particles, predominantly low-density lipoprotein cholesterol (LDL-C), which is associated with accelerated atherogenesis and increased cardiovascular risk.

Objectives This study used 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) to investigate whether arterial inflammation is higher in patients with FH and, moreover, whether lipoprotein apheresis attenuates arterial wall inflammation in FH patients.

Methods In total, 38 subjects were recruited: 24 FH patients and 14 normolipidemic controls. All subjects underwent FDG-PET imaging at baseline. Twelve FH patients who met the criteria for lipoprotein apheresis underwent apheresis procedures followed by a second FDG-PET imaging 3 days (range 1 to 4 days) after apheresis. Subsequently, the target-to-background ratio (TBR) of FDG uptake within the arterial wall was assessed.

Results In FH patients, the mean arterial TBR was higher compared with healthy controls (2.12 ± 0.27 vs. 1.92 ± 0.19; p = 0.03). A significant correlation was observed between baseline arterial TBR and LDL-C (R = 0.37; p = 0.03) that remained significant after adjusting for statin use (β = 0.001; p = 0.02) and atherosclerosis risk factors (β = 0.001; p = 0.03). LDL-C levels were significantly reduced after lipoprotein apheresis (284 ± 118 mg/dl vs. 127 ± 50 mg/dl; p < 0.001). There was a significant reduction of arterial inflammation after lipoprotein apheresis (TBR: 2.05 ± 0.31 vs. 1.91 ± 0.33; p < 0.02).

Original languageEnglish
Pages (from-to)1418-1426
Number of pages9
JournalJournal of the American College of Cardiology
Issue number14
StatePublished - 7 Oct 2014


  • PET/CT imaging
  • atherosclerosis


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