LDL-
apheresis lowers the
LDL level in patients with severe
hypercholesterolemia. The present study compared three
apheresis methods--DSA, DALI, and
plasma exchange--for effectiveness in removal of
LDL and effect on various blood parameters involved in
atherogenesis. The study group included 6 patients with primary
hypercholesterolemia unresponsive to maximal
drug therapy. All were treated first with 4 consecutive
plasma exchange sessions followed by 4 DSA sessions; in four out of six, an additional 4 sessions of DALI were then performed. Levels of
lipoproteins,
apoproteins, CRP,
homocysteine,
fibrinogen, and blood count were determined before and after each session. All 3 procedures yielded a significant reduction in total
cholesterol and
ApoB-containing
lipoproteins, with DALI being the most effective. Also, a significant reduction in
triglycerides, HDL, and ApoA1 was observed with all the methods. The reduction in HDL-C with DSA and DALI was greater than previously reported. The
LDL/
HDL-cholesterol ratio decreased significantly with DSA and DALI and increased with
plasma exchange. There was a significant decrease in CRP,
fibrinogen, and platelets with all three methods, and a significant decrease in
homocysteine only with DSA and DALI. All three procedures effectively reduced the concentration of various compounds involved in
atherosclerosis.
Plasma exchange is nonselective and cannot be recommended as the procedure of choice.