In 40 patients (22 women, 18 men) suffering from
familial hypercholesterolemia resistant to diet and
lipid lowering drugs,
low-density lipoprotein (
LDL)
apheresis was performed over 84.9 +/- 43.2 months. Four different systems (Liposorber, 28 of 40, Kaneka, Osaka, Japan; Therasorb, 6 of 40, Baxter, Munich, Germany; Lipopak, 2 of 40, Pocard, Moscow, Russia; and Dali, 4 of 40, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 50.6% for total
cholesterol, 52.2% for
LDL, 64.3% for
lipoprotein (a) (Lp[a]), and 43.1% for
triglycerides, and an average increase of 10.3% for
high-density lipoprotein (HDL) were reached. Severe side effects such as
shock or
allergic reactions were very rare (0.5%) in all methods. In the course of treatment, an improvement in general well being and increased performance were experienced by 39 of 40 patients. Assessing the different
apheresis systems used, at the end of the trial, there were no significant differences with respect to the clinical outcome experienced with the patients' total
cholesterol, LDL, HDL, and
triglyceride concentrations. However, to reduce high Lp(a) levels, the immunoadsorption method with special Lp(a) columns (Lipopak) seems to be most effective: -59% versus -25% (Kaneka) - (Baxter), and -29% (Dali). The present data demonstrate that treatment with
LDL apheresis of patients suffering from
familial hypercholesterolemia resistant to maximum
conservative therapy is very effective and safe even in long-term application.