LOW-DENSITY-LIPOPROTEIN APHERESIS VERSUS LIPID-LOWERING DRUGS IN THE TREATMENT OF SEVERE HYPERCHOLESTEROLEMIA - 4 YEARS EXPERIENCE

Elevated lipoprotein concentrations seem to be linked strongly in a do se dependent manner to an increased incidence of atherosclerosis. A to tal of 47 patients suffering from severe hyperlipidemia were matched t o treatment with LDL apheresis (Baxter, Kaneka, Lipopak; 24 patients, aged 50.2 +/- 11.5 years), diet, and/or lipid-lowering drugs or with d iet and lipid-lowering drugs only (23 patients, aged 48.8 +/- 11.8 yea rs). After treatment periods of 49.8 +/- 13.4 months (apheresis group, 2,396 treatment sessions) and 38.6 +/- 15.1 months (drug group), the ensuing results revealed significant differences (p < 0.0001): -47.3% versus -12.1% for total cholesterol, -46.9% versus -21.8%; for LDL, +8 .4% versus +0.9% for HDL, -52.0% versus -13.1% for the LDL/HDL ratio, -36.4% versus -16.2% for triglycerides, and -25.9% versus +1.5% for li poprotein (a). In the apheresis group, one patient died of myocardial infarction; in the drug group, there was one nonfatal myocardial infar ction and the manifestation of coronary heart disease in 3 cases. Ther e were no severe side effects in either group. All patients in the aph eresis group responded to therapy. The present trial suggests that a c ontinuing reduction in serum lipid concentrations may lower, in a dose dependent manner, the risk for development and progression of coronar y heart disease. Regarding clinical and laboratory results, LDL aphere sis seems to be safe, effective therapy for treatment of severe hyperl ipidemia.