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[The long-term therapy of familial hypercholesterolemia with heparin-induced extracorporeal LDL precipitation]
Insights
Heparin-induced extracorporeal LDL precipitation (HELP), combined with lipid-lowering drugs and diet, effectively reduced LDL cholesterol in familial hypercholesterolemia patients. This combination therapy offers a reliable long-term solution for managing high cholesterol levels.
Area of Science:
- Cardiology
- Biochemistry
- Medical Technology
Context:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol levels.
- Effective long-term management of FH is crucial to prevent premature atherosclerosis.
- Existing therapies may have limitations in achieving sustained LDL reduction.
Purpose:
- To evaluate the long-term tolerance and effectiveness of Heparin-induced extracorporeal LDL precipitation (HELP) combined with lipid-lowering drugs and diet.
- To assess the efficacy of different treatment phases involving HELP, lovastatin, and cholestyramine.
- To determine if the combined regimen can maintain LDL cholesterol below the atherosclerosis threshold.
Summary:
- Six FH patients underwent a 50-month study with three treatment phases: HELP plus conventional drugs, lovastatin/cholestyramine, and HELP with lovastatin/cholestyramine.
- LDL cholesterol levels were significantly reduced in all phases, from baseline levels around 306 mg/dl to as low as 136 mg/dl.
- The combined therapy was generally well-tolerated, with iron loss being the main biochemical change requiring substitution.
Impact:
- The combined HELP, lovastatin, and ion exchange therapy offers a novel, effective, and reliable approach for long-term LDL cholesterol reduction in FH.
- This regimen successfully lowered mean LDL cholesterol below the critical atherosclerosis threshold of 120 mg/dl.
- The findings suggest a promising therapeutic strategy for managing severe hypercholesterolemia and reducing cardiovascular risk.
Abstract:
The long-term tolerance to and effectiveness of heparin-induced extracorporeal LDL precipitation (HELP) in combination with lipid reducing drugs and diet was tested in six patient (5 males, 1 female; mean age 48 +/- 4 years). Follow-up period was over 50 months, in one patient over 24 months, while one man had a sudden cardiac death 57 weeks after starting treatment. The study was divided into three phases. In phase I (24 months) treatment consisted of HELP and conventional lipid-reducing drugs; in phase II (12 months) of lovastatin (80 mg daily) and cholestyramine (12-24 g daily); and phase III (14 months) of HELP, lovastatin and cholestyramine. In phase I it was possible to lower the pre-treatment level of LDL-cholesterol from 306 +/- 18 mg/dl to 173 +/- 13 mg/dl (43.5%). A similar effect (from 307 +/- 21 mg/dl to 155 +/- 17 mg/dl [-49.5%]) was obtained in phase II. The resumption of HELP reduced the pre-treatment LDL concentration to 136 +/- 9 mg/dl (-55.7%). The various treatment regimens were well tolerated. Biochemical data remained unchanged except for iron loss requiring substitution. Thus combined HELP, lovastatin and ion exchange offer for the first time an effective and reliable means in familial hypercholesterolaemia of clearly reducing long-term the mean LDL cholesterol level below the atherosclerosis threshold of 120 mg/dl.