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Efficacy of different low-density lipoprotein apheresis methods
K G Parhofer1, H C Geiss, P Schwandt
1Medical Department II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. parhofer@med2.med.uni-muenchen.de
Summary
Four apheresis systems effectively lower LDL cholesterol, but Heparin Extracorporeal LDL precipitation (HELP), immunoadsorption, and dextran-sulfate show superior lipoprotein removal. Individual patient factors guide the optimal choice for hypercholesterolemia treatment.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Clinical Chemistry
Background:
- Low-density lipoprotein (LDL) apheresis is crucial for managing drug-resistant hypercholesterolemia and coronary heart disease.
- Multiple apheresis systems exist, utilizing diverse elimination principles.
- Comparing their efficacy in lipoprotein reduction is essential for clinical decision-making.
Purpose of the Study:
- To compare the lipoprotein elimination efficacy of four distinct apheresis systems.
- To evaluate the effectiveness of Heparin Extracorporeal LDL precipitation (HELP), immunoadsorption, dextran-sulfate adsorption, and cascade filtration.
Main Methods:
- A comparative study involving 7 patients on HELP, 10 on immunoadsorption, 8 on dextran-sulfate, and 4 on cascade filtration.
- Evaluation of ten apheresis sessions per patient undergoing long-term treatment (>6 months).
- Measurement of total cholesterol, LDL cholesterol (LDL-C), lipoprotein a [Lp(a)], triglycerides, and HDL levels pre- and post-apheresis.
Main Results:
- All four systems reduced total cholesterol by ~50%.
- HELP, immunoadsorption, and dextran-sulfate demonstrated superior LDL-C (64-67%) and Lp(a) (61-64%) reduction compared to cascade filtration (56% and 53%, respectively).
- HELP showed the highest LDL-C reduction per plasma volume treated (25.0%/L), but is limited by fibrinogen reduction; immunoadsorption has no such limitation.
Conclusions:
- Heparin Extracorporeal LDL precipitation (HELP), immunoadsorption, and dextran-sulfate apheresis are more effective for LDL-C and Lp(a) reduction than cascade filtration.
- The choice of apheresis system requires individualization based on patient's LDL concentration, pharmacotherapy, and fibrinogen levels.
- Optimizing apheresis therapy necessitates considering system efficiency and patient-specific constraints.