EFFECTIVENESS OF CASCADE FILTRATION PLASMAPHERESIS IN 2 PATIENTS AFFECTED BY FAMILIAL HYPERCHOLESTEROLEMIA

Hypercholesterolemia has been recognised as a primary risk factor for coronary heart disease. Reduction of plasma levels of total and LDL ch olesterol has been shown to decrease coronary atherosclerosis. Plasmap heresis represents an useful non-pharmacological tool to treat severe hypercholesterolemias. We have evaluated the effectiveness of a system of plasmapheresis using a cascade filtration method in two young male subjects (aged 16 and 26 years) with homozygous familial hypercholest erolemia. Bath showed severe coronary atherosclerosis as determined by angiography. Procedures were performed at intervals of 7 days in each case. We observed a mean reduction of plasma levels of total choleste rol of 59.5% (range 31.0-75.5%); LDL-cholesterol, 61.6% (range 32.6-77 .1%); triglycerides, 48.1%; HDL-cholesterol, 31.1%; apo A-I, 30.8%; an d apo B, 57.6%. We also noted a reduction of other parameters, such as fibrinogen (49.9%) and Lp(a) (59.9%). At the end of each procedure ab out 8 g of cholesterol was removed from the total body pool. A decreas e of total proteins (26.9%) and albumin (19.6%) was also observed, but this was completely restored before the next apheresis (1 week). Thes e data show the effectiveness of the removal of LDL in a cascade filtr ation system, which obtains results not very different from other more selective methods. The lack of selectivity is not much of a problem, since it also reduces other risk factors such as Lp(a) and fibrinogen. (C) 1995 Wiley-Liss, Inc.