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The HELP-system in the treatment of severe hypercholesterolaemia: acute and long-term experience
1Institute for Clinical Chemistry, Klinikum Grosshadern, München, FRG.
Insights
The HELP procedure effectively lowers high LDL concentrations and Lp(a) in severe hypercholesterolemia patients. This innovative treatment offers a reproducible, safe method for managing cardiovascular risk factors.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
Background:
- Severe hypercholesterolemia is characterized by elevated low-density lipoprotein (LDL) concentrations.
- Elevated Lp(a) and fibrinogen are independent risk factors for coronary heart disease (CHD).
- Current treatments may have limitations or side effects.
Purpose of the Study:
- To evaluate the efficacy of the HELP procedure in treating severe hypercholesterolemia.
- To assess the impact of HELP on Lp(a) and fibrinogen levels.
- To explore the potential for CHD regression with HELP treatment.
Main Methods:
- The HELP (Heparin-mediated LDL/Lp(a) Apheresis) procedure was employed.
- Patients received combination therapy with HMG-CoA-reductase inhibitors.
- Coronary angiographies were performed after 2 years of treatment in a subset of patients.
Main Results:
- The HELP procedure significantly reduced LDL concentrations, achieving a mean reduction of -75% when combined with statins.
- The treatment also demonstrated a notable reduction in Lp(a) and fibrinogen levels.
- Preliminary data from coronary angiographies suggest potential for CHD regression.
Conclusions:
- The HELP procedure is a safe and reproducible method for managing severe hypercholesterolemia, with the added benefit of lowering Lp(a) and fibrinogen.
- This apheresis technique offers a promising therapeutic option for patients at high risk of premature coronary sclerosis.
- Further research is warranted to determine optimal treatment levels and long-term outcomes, including CHD regression.
Abstract:
The HELP procedure provides a new means of treating high LDL concentrations in severe hypercholesterolemia with the unique additional effect of lowering Lp(a) and fibrinogen. In combination with HMG-CoA-reductase inhibitors a mean interval value of -75% for LDL as compared to the starting concentration may be achieved. The treatment has the advantage that the patient is not exposed to foreign proteins or compounds with attendant immunological problems. It displays a high degree of reproducibility and an almost unlimited capacity guaranteeing a constant therapy independent of the clinic performing the treatment. The first coronary angiographies after 2 years of HELP treatment in over 50 patients (to be reported elsewhere) give support to the hope that regression of coronary heart disease is possible in humans. Further studies and observations should eventually tell us at what level of LDL, Lp(a) and fibrinogen this may be expected. We trust that the clinical benefit of this treatment regimen will be substantial for those patients who have problems in clearing LDL from their plasma pool and who are at the same time sensitive to elevated LDL-levels by the development of premature coronary sclerosis.