Atherosclerosis with
myocardial infarction,
stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial
hypertension,
diabetes mellitus, and
central obesity. Furthermore, there is a strong correlation between
hyperlipidemia and
atherosclerosis. The prognosis of patients suffering from severe
hyperlipidemia, sometimes combined with elevated
lipoprotein (a) (Lpa) levels, and
coronary heart disease (CHD) 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 four different
LDL apheresis systems available: immunoadsorption,
heparin-induced extracorporeal
LDL/
fibrinogen precipitation,
dextran sulfate LDL adsorption and
LDL hemoperfusion. Regarding the different
LDL apheresis systems used, there is no significant difference with respect to the clinical outcome or concerning total
cholesterol, LDL,
high-density lipoprotein (HDL), or
triglyceride concentrations. With respect to elevated Lpa levels, however, the immunoadsorption method seems to be the most effective. In 45 patients (25 women, 20 men) suffering from
familial hypercholesterolemia resistant to diet and
lipid lowering drugs,
low-density lipoprotein (
LDL)
apheresis was performed over 95.6 +/- 44.7 months. Four different systems (Liposorber, 32 of 45, Kaneka, Osaka, Japan; Therasorb, 6 of 45, Baxter, Munich, Germany; Lipopak, 2 of 45, Pocard, Moscow, Russia; and Dali, 5 of 45, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 57% for total
cholesterol, 55.9% for
LDL, 75.8% for
lipoprotein a (Lpa), and 45.9% for
triglycerides, and an average increase of 14.3% for HDL were reached. Severe side-effects such as
shock or
allergic reactions were very rare (0.3%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 44 of 45 patients. 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.