[Effects of LDL-apheresis--more than reduction of cholesterol?]

LDL apheresis is a safe and very effective extracorporeal treatment of refractory hypercholesterolemia. LDL cholesterol levels can be reduced with this procedure by more than 60%. C-reactive protein (CRP) is a known marker of inflammation in atherosclerosis. Interestingly CRP can be effectively removed by a single LDL apheresis, but further studies are needed to substantiate the effect of extracorporeal reduction of CRP on the progression of atherosclerosis. However, adhesion molecules and activities of inflammatory cells were also found to be reduced after a single LDL apheresis. The biochemical composition of newly formed LDL particles after apheresis is altered: LDL particles isolated after LDL apheresis had an increased resistance to oxidative stress in vitro. In addition, antioxidants are not depleted by LDL apheresis. The extracorporal method itself does not have a negative impact on the oxidative/antioxidative balance. A recent investigation showed that LDL-cholesterol had a more pronounced effect on blood rheology than fibrinogen. This observation may explain why a single LDL apheresis leads to better myocardial perfusion, as demonstrated by PET in patients with hypercholesterolemia. These additional effects have so far only been known with statins. Further investigations are needed to substantiate the observed potentially beneficial effects of LDLapheresis beyond its effect of lowering LDL.