Long-term reduction of C-reactive protein concentration by regular LDL apheresis

Abstract

Backround: Increased C-reactive protein (CRP) concentration is an independent risk predictor for coronary heart disease (CHD). A therapeutic reduction of CRP might, therefore, reduce the risk of cardiovascular events. A single LDL apheresis lowers LDL cholesterol by 45–70%, and CRP by 20–65%, however, less is known about the long-term effects of LDL apheresis on CRP levels. Methods: We investigated 34 CHD patients (20 males, 14 females, 52±10 years) on statin therapy who were regularly treated by LDL apheresis because of drug-resistant hypercholesterolemia. Measurements of CRP (ultrasensitive nephelometric assay) were performed before the first apheresis, before a current apheresis (1 or 2 weeks after the last apheresis), and after a current apheresis (treatment period: 5.3±4.2 years, range: 0.25–12.5 years). LDL apheresis was performed by immunoadsorption ( n=6), dextran sulfate adsorption ( n=13), heparin-induced extracorporal LDL precipitation (HELP, n=9), or direct adsorption of lipoproteins (DALI, n=6). Results: CRP was significantly lower before a current apheresis (median: 0.75 mg/l, range: 0.16–4.33 mg/l) compared to before the first apheresis (median: 0.85 mg/l, range: 0.16–7.02 mg/l; P<0.05). As expected, total and LDL cholesterol were lower before a current apheresis compared to before the initial apheresis while fibrinogen concentration did not differ significantly. Conclusion: Over the period of more than 5 years LDL apheresis slightly, but significantly reduced CRP concentrations in patients with CHD on statin therapy, which may contribute to the stabilization of atherosclerosis in hypercholesterolemic patients treated with LDL apheresis. These results are even more impressive when the known age-related increase in CRP over the treatment period is taken into account.