[Maximal treatment of hypercholesteremia: what is possible?]

A therapeutic strategy is presented which combines the use of HMG-CoA (3-hydroxy-3-methylglutaryl-CoA) reductase inhibitors with extracorporeal HELP-apheresis for the simultaneous elimination of LDL and plasma fibrinogen to ideal plasma concentrations. With HELP-treatment alone LDL (low density lipoprotein)-cholesterol and fibrinogen could be reduced to approx. 50-60% of original plasma levels; medication with HMG-CoA reductase inhibitors alone caused a LDL-cholesterol decrease by a mean of 40% from the untreated values. A combination of both methods led to a reduction in the LDL-cholesterol values of 70-80%. The high efficacy and safety of this combined treatment in patients with coronary artery disease (CAD) offers the possibility to normalize even markedly severe heterozygous hypercholesterolemia with plasma-LDL concentrations of about 450 mg/dl to ideal LDL-levels of below 120 mg/dl. This therapeutic strategy may be useful in the secondary prevention of CAD in patients with and without familial hypercholesterolemia if plasma cholesterol cannot be reduced by diet and drug treatment to a sufficient extent. Presumably one to two years of treatment will be required to retard the CAD and could initiate a regression of coronary sclerosis.