There are now several efficient and safe extracorporeal
LDL eliminating procedures for the treatment of patients with
familial hypercholesterolemia (FH) resistant to diet and combined
drug therapy. In Germany, the most clinical experience is available from the
heparin-induced extracorporeal
LDL-precipitation (HELP) system. This procedure is additionally characterized by the effective elimination of not only
LDL but also
fibrinogen, a further independent risk factor of
coronary heart disease CHD, which mainly influences blood flow characteristics. After 3-4 HELP treatments at weekly intervals, patients with CHD report markedly fewer episodes of
angina pectoris, previously resistant to conventional
therapy. This is probably related to a "functional regression" of CHD, which is due to the simultaneous lowering of
LDL and
fibrinogen, resulting in improved rheological properties followed by an increased
oxygen supply to a previously insufficiently perfused myocardium. The restoration of endothelial function by maximal
cholesterol lowering, as indirectly shown by changes in the
cholesterol/
phospholipid ratio in cellular membranes, obviously results in an improved vasomotoric response to endogenous vasodilatative substances, thus explaining the clinical improvement of our patients. As shown by a multicenter trial, regular long-term treatment with HELP is followed by an arrest of the atherosclerotic progression in 50% of the investigated segments. In 30% of the previously progressive segments, a significant regression was observed while only 20% of the segments progressed. The mean degree of
stenosis decreased by 4.3%. Regular HELP-
LDL-/
Fibrinogen apheresis in patients with severe CHD and
angina pectoris refractory to conventional
therapy results within a relatively short period in an improved coronary perfusion and long-term treatment induces regression of atherosclerotic coronary lesions.