Low density lipoprotein (LDL) apheresis is one type of therapy currently being used for coronary artery disease; however, there has been no study to compare the effectiveness of this therapy with the effectiveness of other treatments, such as coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). In this study, we evaluated the clinical results of these three therapies to compare their individual effectiveness for the treatment of coronary artery disease. Forty-four patients with two vessel disease (plasma cholesterol levels > 250 mg/dl) were divided into three groups (L, LDL apheresis; C, CABG; I, PTCA). After 2 years' observation, the coronary artery findings were evaluated by quantitative coronary angiography (QCA), frequency of cardiac events, changes in plasma lipids, and subjective symptoms, and the cost was examined. The symptoms of patients in Groups C and I showed significant improvement when compared with those of Group L. In Group L, the frequency of cardiac events was low (L, 0%; P, 44%; C, 14%), and lipid reduction was marked (L, 48%; P, 13%; C, 14%); however, the cost of this therapy is much more than the other therapies. There was no difference in the minimal luminal diameter evaluated by QCA in the three groups. LDL apheresis may be a good strategy for coronary disease, if its cost can be improved.