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Micro‐ and Macrocirculatory Effects of Apheresis in Patients withFamilial Hyperlipidemia

High lipid levels have been shown to coexist with a disturbedvascular endothelial function. Thus, acute lipid lowering couldbe expected to improve vascular reactivity. Patients with familialhyperlipidemia (FH) have substantial and rapid decreases in lipidlevels after low‐density lipoprotein apheresis. Thus, an opportunityexists to study acute effects of lipid lowering on vascular reactivity.Flow mediated vasodilation (FMD) is commonly used to assess endothelialfunction in conduit vessels, whereas vital capillary microscopyduring the post‐reactive hyperemia (PRH) phase is used to assessresponse at the microvascular level. It is not known whether endothelialdysfunction is a general phenomenon in all kinds of vessels or ifthere are differences between micro‐ and macrovessels. In the presentstudy, we were not able to demonstrate an improved vascular responseafter acute lipid lowering in FH patients. This was true both inthe microcirculation (PRH) and in the conduit vessels (FMD). However,the two methods gave concordant results, demonstrating disturbedvascular reactivity in the patients as compared with healthy subjects.We have found no previous report with parallel assessments at themicrocirculatory and macrocirculatory levels.