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Long term effect of LDL apheresis on coronary heart disease
M G Donner1, W O Richter, P Schwandt
1Medical Department II, Klinikum Grosshadern, Marchioninistr. 15, Munich D-81377, Germany.
Insights
LDL apheresis combined with statins effectively lowers LDL cholesterol in patients with severe hypercholesterolemia, stabilizing coronary atherosclerosis when drugs alone fail.
Area of Science:
- Cardiology
- Metabolic Disorders
- Vascular Medicine
Background:
- Severe hypercholesterolemia and coronary heart disease (CHD) often require advanced treatments beyond standard lipid-lowering drugs.
- Patients with refractory hypercholesterolemia pose a significant challenge in managing cardiovascular risk.
Purpose of the Study:
- To evaluate the efficacy of LDL apheresis combined with maximally tolerated statin therapy in patients with CHD and severe, drug-refractory hypercholesterolemia.
- To assess the impact of this combined treatment on coronary lesion progression and overall cardiovascular outcomes.
Main Methods:
- A cohort of 34 patients with heterozygous familial hypercholesterolemia and CHD received weekly or biweekly LDL apheresis.
- Simvastatin was added at maximally tolerable doses after an initial period of apheresis.
- Coronary angiographies were used to evaluate changes in coronary lesions over the observation period.
Main Results:
- LDL apheresis significantly reduced LDL cholesterol levels, from a baseline average of 230.8–265.4 mg/dl to 123.7–138.8 mg/dl during the final treatments.
- Coronary lesion regression was observed in 8.8% of patients, with stabilization of atherosclerosis in the remainder.
- Three patients (8.8%) experienced cardiac complications, including death, during the study period.
Conclusions:
- Combined LDL apheresis and aggressive lipid-lowering drug therapy can effectively stabilize coronary atherosclerosis in patients with severe, refractory hypercholesterolemia.
- This intensive treatment approach offers a viable option for managing complex lipid disorders and associated cardiovascular disease.
Abstract:
LDL-apheresis is a treatment option for patients with coronary heart disease and severe hypercholesterolemia not adequately responding to drug treatment. 34 patients (21 men, 13 women), aged 47 +/- 9 years, with coronary heart disease and heterozygous familial hypercholesterolemia not adequately responsive to lipid lowering drugs received weekly (4 patients biweekly) LDL apheresis for 3.5 +/- 2.5 years, after 0.5 - 3.0 years simvastatin in the maximally tolerable dose was added. Baseline LDL cholesterol concentration under diet and lipid lowering drugs in the patients receiving immunoadsorption, dextran sulfate adsorption and HELP apheresis was 265.4 +/- 54.9, 230.8 +/- 75.8 and 253.7 +/- 55.7 mg/dl, respectively. The calculated mean LDL cholesterol concentration of the last 5 treatments of the observation period was 123.7 +/- 22.8, 126.8 +/- 26.7 and 138.8 +/- 19.7 mg/dl, respectively. The evaluation of coronary angiographies revealed a definite regression of coronary lesions in 3 patients (8.8%), in all other patients there was a stop in progression. 3 patients died of cardiac complications during the observation period. We conclude that aggressive lipid lowering with combined LDL-apheresis and drugs can stabilize coronary atherosclerosis in most patients with refractory hypercholesterolemia.