Familial hypercholesterolemia is a disorder of lipid metabolism associated with a highly increased risk for
cardiovascular disease. Since in such patients even combined
drug therapy often fails to decrease
low-density lipoprotein (
LDL) cholesterol levels sufficiently, extracorporeal
LDL elimination has been developed. We treated eight adult patients with
LDL immunoadsorption using
antibodies against
apolipoprotein B without additional
lipid-lowering
drug therapy for 3 years; this procedure was performed at weekly intervals. By one treatment session,
LDL cholesterol and
lipoprotein(a) levels were decreased by 55%. Under regular treatment, mean
LDL cholesterol levels of 165 mg/dL between two consecutive treatment sessions could be reached, compared with 522 +/- 24 mg/dL before any treatment. As
high-density lipoprotein (
HDL) cholesterol levels increased under regular treatment, the
LDL/
HDL cholesterol ratio decreased from 13.4 to 3.4. Positive influences on plasma and whole-blood viscosity as well as on erythrocyte aggregation also seem to be beneficial with regard to retarding
atherosclerosis.
Very-low-density lipoprotein (VLDL) levels were reduced by approximately 50%
after treatment, accompanied by a marked increase of
lipoprotein lipase (LPL) and hepatic
triglyceride lipase (HTGL) activity. The effects of
LDL apheresis on hemostasis, complement activation
transport proteins, and hematological parameters were found to be small. In addition, no side effects amounting to any major clinical relevance occurred in any of the patients. After 3 years of
LDL apheresis, a decrease in the frequency of anginal
chest pain and ST segment depression on exercise testing and a marked reduction of tendon
xanthoma size were observed.