The prognosis of patients suffering from severe
hyperlipidemia, sometimes combined with elevated
lipoprotein (a) (Lp[a]) levels, and
coronary heart disease (CHD) refractory to diet and
lipid-lowering drugs is poor. For such patients, regular treatment with
low-density lipoprotein (
LDL)
apheresis is the therapeutic option. Today, there are four different
LDL-
apheresis systems available: immunoadsorption,
heparin-induced extracorporeal
LDL/
fibrinogen precipitation,
dextran sulfate LDL-adsorption, and
LDL-
hemoperfusion. Despite substantial progress in diagnostics,
drug therapy, and cardiosurgical procedures,
atherosclerosis with
myocardial infarction,
stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial
hypertension,
diabetes mellitus, and
central obesity. Furthermore, there is a strong correlation between
hyperlipidemia and
atherosclerosis. Besides the elimination of other risk factors, in severe
hyperlipidemia (HLP) therapeutic strategies should focus on a drastic reduction of serum
lipoproteins. Despite maximum conventional
therapy with a combination of different kinds of
lipid-lowering drugs, however, sometimes the goal of
therapy cannot be reached. Mostly, the prognosis of patients suffering from severe HLP, sometimes combined with elevated Lp(a) levels and CHD refractory to diet and
lipid-lowering drugs is poor. Hence, in such patients, treatment with
LDL-
apheresis can be useful. Regarding the different
LDL-
apheresis systems used, there were no significant differences with respect to the clinical outcome or concerning total
cholesterol, LDL,
high-density lipoprotein, or
triglyceride concentrations. With respect to elevated Lp(a) levels, however, the immunoadsorption method seems to be the most effective. The published data clearly demonstrate that treatment with
LDL-
apheresis in patients suffering from severe
hyperlipidemia refractory to maximum
conservative therapy is effective and safe in long-term application.