The prognosis of patients suffering from severe
hyperlipidemia, sometimes combined with elevated
lipoprotein (a) levels, and
coronary heart disease 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 five different
LDL-
apheresis systems available: cascade filtration or
lipid filtration, immunoadsorption,
heparin-induced
LDL precipitation,
dextran sulfate LDL adsorption, and the
LDL hemoperfusion. There is a strong correlation between
hyperlipidemia and
atherosclerosis. Besides the elimination of other risk factors, in severe
hyperlipidemia 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, sometimes the goal of
therapy cannot be reached. Hence, in such patients, treatment with
LDL-
apheresis is indicated. Technical and clinical aspects of these five different
LDL-
apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or
triglycerides observed. With respect to elevated
lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different 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.