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Effect of HELP-LDL-apheresis on outcomes in patients with advanced coronary atherosclerosis and severe
Insights
HELP-therapy (heparin-induced, extracorporeal LDL precipitation) effectively lowers lipids in patients with severe hypercholesterolemia. This LDL apheresis treatment improves clinical outcomes for most patients with advanced coronary artery disease.
Area of Science:
- Cardiology
- Vascular Biology
- Lipid Metabolism
Background:
- Secondary prevention of coronary artery disease (CAD) benefits from lipid lowering.
- LDL apheresis is a viable option for patients unresponsive to conventional therapies.
- Advanced coronary atherosclerosis and severe hypercholesterolemia necessitate aggressive lipid management.
Purpose of the Study:
- To evaluate the clinical and angiographic impact of heparin-induced, extracorporeal LDL precipitation (HELP-therapy).
- To assess the efficacy of LDL apheresis in patients with refractory hypercholesterolemia and advanced CAD.
Main Methods:
- Prospective trial involving 44 patients with severe hypercholesterolemia and advanced CAD.
- Patients received weekly LDL apheresis (HELP-therapy) for an average of 15.5 months.
- Measurements included lipid profiles (Total Cholesterol, LDL-C, Lp(a)), fibrinogen, clinical status, and coronary angiography.
Main Results:
- HELP-therapy significantly reduced mean levels of Total Cholesterol (44.8%), LDL-C (55.5%), Lp(a) (60.8%), and fibrinogen (53.8%) per treatment.
- Clinical improvement (exercise tolerance, reduced angina) was observed in 73% of patients.
- Despite 40% showing angiographic CAD progression, 80% of these patients experienced clinical improvement.
Conclusions:
- Chronic weekly HELP-therapy safely and effectively lowers LDL-C, Lp(a), and fibrinogen in patients with advanced CAD and severe hypercholesterolemia.
- The majority of patients achieve clinical improvement with HELP-therapy, even those with evidence of ongoing CAD progression.
- LDL apheresis offers a valuable therapeutic option for managing complex lipid disorders in secondary CAD prevention.
Abstract:
In the secondary prevention of coronary artery disease (CAD) the beneficial effect of lipid lowering is no longer controversial. LDL-apheresis is a feasible therapy for effective lipid lowering in patients refractory to diet and cholesterol lowering drugs. To assess the impact of the HELP-therapy (heparin-induced, extracorporeal LDL precipitation) on patients' clinical outcome and coronary angiography, we set up a prospective trial, in which patients with advanced coronary atherosclerosis and severe hypercholesterolemia resistant to diet and drug therapy were treated with LDL-apheresis. A total of 44 patients were treated with adjunctive weekly HELP-therapy for 15.5 +/- 9.5 months. The mean levels of total cholesterol (Chol), LDL-cholesterol (LDL-C), Lp(a), and fibrinogen at baseline were 308.0 +/- 69.7, 231.8 +/- 72.7, 82.2 +/- 54.1, and 356.1 +/- 94.1 mg/dl, respectively. LDL-apheresis caused a mean per treatment reduction of 44.8 +/- 8.7, 55.5 +/- 8.6, 60.8 +/- 10.2, and 53.8 +/- 6.5% of Chol, LDL-C, Lp(a), and fibrinogen, resulting in mean treatment interval values of 190.4 +/- 33.7, 116.3 +/- 28.9, 51.9 +/- 33.1, and 213.7 +/- 148.9 mg/dl, respectively. Improvement of the clinical status (exercise tolerance, anti-anginal drug use, angina pectoris) was found in 73%, no change in 11%, and deterioration in 16% of the cases. Four patients died cardiac death. The maximal bicycle exercise work load of the patients increased significantly from 101 +/- 41 to 119 +/- 46 W (P < 0.001). Ten (40%) out of 25 patients who underwent follow-up angiography revealed CAD progression, whereas two (8%) patients had CAD regression. Despite angiographic deterioration eight out of ten progressors (80%) improved clinically. In patients with advanced coronary atherosclerosis and severe hypercholesterolemia HELP-therapy can safely and effectively lower LDL-C, Lp(a), and fibrinogen. The chronic weekly HELP-treatment results in clinical improvement in the majority of patients, even in those patients with angiographically shown CAD progression.