Long-term reduction of C-reactive protein concentration by regular LDL apheresis
Carsten Otto1, H Christian Geiss, Klaus Empen
1Medical Department 2-Grosshadern, University of Munich, Marchioninistrasse 15, D-81377 Munich, Germany. carsten.otto@med.uni-muenchen.de
Insights
Long-term LDL apheresis therapy significantly reduced C-reactive protein (CRP) levels in coronary heart disease (CHD) patients. This reduction in CRP may help stabilize atherosclerosis in hypercholesterolemic individuals.
Area of Science:
- Cardiology
- Biochemistry
- Medical Technology
Background:
- Elevated C-reactive protein (CRP) is a key predictor of coronary heart disease (CHD) risk.
- Therapeutic reduction of CRP may decrease cardiovascular event rates.
- While short-term LDL apheresis reduces CRP, long-term effects remain less understood.
Purpose of the Study:
- To evaluate the long-term impact of regular LDL apheresis on CRP levels in CHD patients.
- To assess if sustained LDL apheresis contributes to CRP reduction over years.
Main Methods:
- 34 CHD patients on statin therapy underwent regular LDL apheresis for drug-resistant hypercholesterolemia.
- CRP levels were measured before the first apheresis, before current apheresis, and after treatment.
- Treatment duration averaged 5.3 years, with various apheresis techniques employed.
Main Results:
- CRP levels were significantly lower before current apheresis compared to before the initial apheresis (P < 0.05).
- LDL cholesterol and total cholesterol also showed reductions over the treatment period.
- Fibrinogen levels did not exhibit significant changes.
Conclusions:
- Regular LDL apheresis leads to a modest but significant long-term reduction in CRP concentrations in CHD patients.
- This sustained CRP reduction may aid in stabilizing atherosclerosis.
- The findings are notable considering the typical age-related increase in CRP.
Background:
Increased C-reactive protein (CRP) concentration is an independent risk predictor for coronary heart disease (CHD). A therapeutic reduction of CRP might, therefore, reduce the risk of cardiovascular events. A single LDL apheresis lowers LDL cholesterol by 45-70%, and CRP by 20-65%, however, less is known about the long-term effects of LDL apheresis on CRP levels.
Methods:
We investigated 34 CHD patients (20 males, 14 females, 52 +/- 10 years) on statin therapy who were regularly treated by LDL apheresis because of drug-resistant hypercholesterolemia. Measurements of CRP (ultrasensitive nephelometric assay) were performed before the first apheresis, before a current apheresis (1 or 2 weeks after the last apheresis), and after a current apheresis (treatment period: 5.3 +/- 4.2 years, range: 0.25-12.5 years). LDL apheresis was performed by immunoadsorption (n = 6), dextran sulfate adsorption (n = 13), heparin-induced extracorporal LDL precipitation (HELP, n = 9), or direct adsorption of lipoproteins (DALI, n = 6).
Results:
CRP was significantly lower before a current apheresis (median: 0.75 mg/l, range: 0.16-4.33 mg/l) compared to before the first apheresis (median: 0.85 mg/l, range: 0.16-7.02 mg/l; P < 0.05). As expected, total and LDL cholesterol were lower before a current apheresis compared to before the initial apheresis while fibrinogen concentration did not differ significantly.
Conclusion:
Over the period of more than 5 years LDL apheresis slightly, but significantly reduced CRP concentrations in patients with CHD on statin therapy, which may contribute to the stabilization of atherosclerosis in hypercholesterolemic patients treated with LDL apheresis. These results are even more impressive when the known age-related increase in CRP over the treatment period is taken into account.
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