LOW-DENSITY-LIPOPROTEIN APHERESIS IN THE TREATMENT OF 2 PATIENTS WITHCORONARY HEART-DISEASE AND EXTREMELY ELEVATED LIPOPROTEIN-(A) LEVELS

Hyperlipidemia and elevated lipoprotein (a) (Lp[a]) levels have been l inked to the development and progression of premature atherosclerosis. Our study concerned 2 white male patients (aged 36 and 42 years) with heterozygous familial hypercholesterolemia and extremely elevated Lp( a) concentrations that were resistant to diet regimens and lipid-lower ing drugs. The patients were treated with low-density lipoprotein (LDL ) apheresis for 59 months (Liposorber system, Kaneka, Japan) and 19 mo nths (immunoadsorption system, special Lp(a) columns; Lipopak; Pocard, Russia), respectively. The concentration of Lp(a) decreased on averag e by 50%, total cholesterol by 27%, LDL cholesterol by 41%, triglyceri des by 43%, and fibrinogen by 16%. High-density lipoprotein (HDL) chol esterol increased by approximately 4%. Before treatment with LDL apher esis, each patient had suffered 3 myocardial infarctions, and had had 4 and 6 coronary angiographies with 2 and 4 percutaneous transluminal angioplasties (PTCAs), respectively. Since treatment with LDL apheresi s, no myocardial infarctions or cardiac complaints were observed. In t he course of treatment, both patients reported an increased performanc e. Available data suggest that LDL apheresis may be effective in the t reatment of patients, the only risk factor for premature atheroscleros is being extremely elevated Lp(a) concentrations.