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[Maximal therapy of hypercholesterolemia in coronary heart disease]
J Thiery1, V Armstrong, T Bosch
1Institut für Klinische Chemie, Ludwig-Maximilians-Universität, München.
Insights
This study combined LDL apheresis (HELP) with statins to significantly lower LDL cholesterol in hypercholesterolemic patients. The combined therapy achieved an 80% reduction, improving blood flow and showing promise for secondary prevention of heart disease.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Nephrology
Background:
- Hypercholesterolemia poses a significant risk for coronary artery disease (CAD).
- Diet and conventional drug therapies may not sufficiently lower LDL cholesterol levels in some patients.
- Extracorporeal LDL apheresis offers a method for drastic reduction of plasma LDL concentrations.
Observation:
- The HELP-system (LDL/fibrinogen apheresis) combined with HMG-CoA reductase inhibitors was evaluated.
- This combined therapy was tested in hypercholesterolemic patients with CAD.
- The treatment duration was two years with no significant adverse effects observed.
Findings:
- HELP treatment alone reduced LDL cholesterol by 50-60%.
- HMG-CoA reductase inhibitors reduced LDL cholesterol by approximately 40%.
- The combination therapy achieved an 80% reduction in mean LDL cholesterol from baseline values.
- Improvements in blood rheology, including decreased plasma viscosity and inhibited erythrocyte aggregation, were observed.
Implications:
- This maximal LDL-cholesterol lowering strategy is beneficial for secondary prevention in hypercholesterolemic CAD patients unresponsive to diet and drugs.
- Preliminary data suggest symptom improvement in CAD patients undergoing combined therapy.
- A combined HELP and dialysis unit will soon be available for patients with end-stage renal insufficiency and atherosclerosis.
Abstract:
Extracorporeal procedures to eliminate LDL from plasma now allow us to drastically lower the plasma LDL-concentrations to virtually every desired level. In a new therapeutic approach the combination of HMG-CoA reductase inhibitors with an LDL/fibrinogen apheresis procedure (the HELP-system) was evaluated in hypercholesterolemic CAD-patients. HELP treatment alone can lower the mean plasma LDL-cholesterol by about 50-60%, HMG-CoA reductase inhibitor therapy reduces the LDL-cholesterol by about 40%. The combination of both treatments resulted in a lowering of mean LDL-cholesterol to about 80% of baseline values. Improvement of blood rheology by lowering plasma viscosity and inhibiting erythrocyte aggregation became apparent. No relevant adverse effects were noted over a period of two years. This therapeutic strategy for maximal LDL-cholesterol lowering may be useful in secondary prevention of coronary heart disease in hypercholesterolemic patients if plasma LDL-C cannot be reduced by diet and drug treatment to desirable plasma levels (LDL-cholesterol less than 120 mg/dl). Preliminary data show an improvement in the symptoms of our CAD-patients treated with this combined therapy. Furthermore, within the near future a combined HELP and dialysis unit will be available for patients with terminal renal insufficiency and progressive atherosclerosis.