CHANGES IN PLASMA-LIPID AND APOLIPOPROTEIN LEVELS BETWEEN HEPARIN-INDUCED EXTRACORPOREAL LOW-DENSITY-LIPOPROTEIN PRECIPITATION (HELP) TREATMENTS

Heparin-induced extracorporeal low-density lipoprotein (LDL) precipita tion (HELP) treatments selectively remove LDL with minimal effects on high-density lipoproteins (HDC), but limited data are available on eff ects treatments. The levels of factors associated with increased coron ary artery disease risk (atherogenic) among treatments may have therap eutic significance, especially for combined HELP and lipid-lowering dr ug therapy. Hypercholesterolemic and combined hyperlipidemic patients resistant to diet/drug therapy were treated with biweekly HELP therapy . Hypercholesterolemic patients received either lovastatin or no drug, whereas combined hyperlipidemic patients received gemfibrozil. Plasma lipid (total cholesterol, triglycerides, LDL cholesterol, and HDL cho lesterol) and apolipoprotein A-I, A-II, B, C-III, and E levels were me asured before treatment, then immediately, and 2, 4, 7, and 14 days af ter treatments (n = 28). Atherogenic factor (LDL cholesterol, total ch olesterol, apolipoprotein B) levels decreased >50% with treatment, gra dually increasing over 14 days to pretreatment levels. Factors associa ted with reduced coronary artery disease risk (HDL cholesterol and apo lipoproteins A-I and A-II) decreased 8% to 16% but recovered 2 days. C omponents of triglyceride-rich and apolipoproteins C-III and E) 38% to 55% with variable post-treat ment recoveries. Lovastatin reduced pret reatment levels of atherogenic and triglyceride-rich lipoprotein compo nents and slowed post-treatment increases compared with no drug therap y. Gemfibrozil produced changes similar to lovastatin. Drug therapy ha d little effect on factors associated with reduced coronary artery dis ease risk. HELP apheresis produced large reductions in plasma atheroge nic factor levels with gradual return to pretreatment levels over 14 d ays, whereas antiatherogenic factors were minimally reduced and recove red rapidly. Lipid-lowering drug therapy reduced pretreatment levels a nd delayed post-treatment increases of both cholesterol- and triglycer ide-rich lipoproteins.