REDUCTION OF LIPOPROTEIN(A) BY LDL-APHERESIS USING A DEXTRAN SULFATE CELLULOSE COLUMN IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA

Lipoprotein(a) (Lp(a)) was eliminated by LDL-apheresis using a dextran sulfate cellulose column in 3 homozygous and 10 heterozygous familial hypercholesterolemic patients. Immediately after LDL-apheresis by the LA- 1 5 system (continuous LDL apheresis), there were significant red uctions in Lp(a) concentrations (28.6 +/- 11.8 mg/dl (mean +/- S.E.) t o 9.6 +/- 5.6 mg/dl (P < 0.01)), and in LDL-cholesterol concentrations (156 +/- 32 mg/dl to 48 +/- 18 mg/dl (P < 0.01)). Immediately followi ng LDL-apheresis, Lp(a) and LDL-cholesterol were reduced by 67.4% +/- 11.6% and 68.3% +/- 11.8%, respectively. The removal of Lp(a) parallel ed that of LDL-cholesterol. The reduced levels of Lp(a) nearly returne d to baseline within 7 days. In 6 of the heterozygous FH patients the rates of recovery of LDL cholesterol and Lp(a) were calculated, accord ing to Apstein's equation after discontinuing lipid altering drug trea tment for 4 weeks. Mean constant k values of LDL cholesterol and Lp(a) were 0.354 (range : 0.136-0.752) and 0.427 (range 0.112-0.933), respe ctively. The average concentration during the 7 days following LDL-aph eresis was calculated. Average reductions were 28% in LDL cholesterol and 18% in Lp(a). Pravastatin treatment, which continued for 4 weeks, significantly decreased LDL cholesterol (P < 0.01); however, before LD L-apheresis pravastatin treatment significantly increased Lp(a) levels (P < 0.05) in a small number (n = 6) of the FH patients, who had been regularly treated with LDL-apheresis. These results suggest that LDL- apheresis using the dextran sulfate cellulose column is an effective t reatment to reduce levels of serum Lp(a) and LDL proportionally. This therapy may be of value in the prevention and regression of coronary a rtery disease in FH patients.