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Nothing to disclose. None. 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. 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). 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. 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). 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. [ABSTRACT FROM AUTHOR]