LDL-apheresis as long-term treatment in severe hyperlipidemia using differing methods.

Abstract

In 34 patients (18 women, 16 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low density lipoprotein (LDL) apheresis was performed during 72.8 + 43.2 months. Four different systems (Liposorber, 28 of 34, Kaneka, Osaka, Japan; Therasorb, 2 of 34, Baxter, Germany; Lipopak 2 of 34, Pocard, Moscow, Russia; Dali, 2 of 34, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 51.9% for total cholesterol, 49.8% for LDL, 69.8% for lipoprotein (a) (Lp(a)), and 58.8% for triglycerides, and an average increase of 9.8% for HDL were reached. Severe side effects such as shock or allergic reactions were very rare (0.5%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 31 of 34 patients. Assessing the different apheresis systems used, at the end of the trial there were no significant differences with respect to the clinical outcome experienced by the patients' total cholesterol, LDL, HDL, and triglyceride concentrations. However, to reduce high Lp(a) levels, the immunoadsorption method with special Lp(a) columns (Lipopak) seems to be most effective: -57% versus -25% (Kaneka), -23% (Baxter), and -29% (Dali). The present data demonstrate that treatment with LDL-apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe, even in long-term application.