EFFECT OF HELP-LDL-APHERESIS ON OUTCOMES IN PATIENTS WITH ADVANCED CORONARY-ATHEROSCLEROSIS AND SEVERE HYPERCHOLESTEROLEMIA

In the secondary prevention of coronary artery disease (CAD) the benef icial effect of lipid lowering is no longer controversial. LDL-apheres is is a feasible therapy for effective lipid lowering in patients refr actory to diet and cholesterol lowering drugs. To assess the impact of the HELP-therapy (heparin-induced, extracorporeal LDL precipitation) on patients' clinical outcome and coronary angiography, we set up a pr ospective trial, in which patients with advanced coronary atherosclero sis and severe hypercholesterolemia resistant to diet and drug therapy were treated with LDL-apheresis. A total of 44 patients were treated with adjunctive weekly HELP-therapy for 15.5 +/- 9.5 months. The mean levels of total cholesterol (Chol), LDL-cholesterol (LDL-C), Lp(a), an d fibrinogen at baseline were 308.0 +/- 69.7, 231.8 +/- 72.7, 82.2 +/- 54.1, and 356.1 +/- 94.1 mg/dl, respectively. LDL-apheresis caused a mean per treatment reduction of 44.8 +/- 8.7, 55.5 +/- 8.6, 60.8 +/- 1 0.2, and 53.8 +/- 6.5% of Chol, LDL-C,Lp(a), and fibrinogen, resulting in mean treatment interval values of 190.4 +/- 33.7, 116.3 +/- 28.9, 51.9 +/- 33.1, and 213.7 +/- 148.9 mg/dl, respectively. Improvement of the clinical status (exercise tolerance, anti-anginal drug use, angin a pectoris) was found in 73%, no change in 11%, and deterioration in 1 6% of the cases. Four patients died cardiac death. The maximal bicycle exercise work load of the patients increased significantly from 101 /- 41 to 119 +/- 46 W (P < 0.001). Ten (40%) out of 25 patients who un derwent follow-up angiography revealed CAD progression, whereas two (8 %) patients had CAD regression. Despite angiographic deterioration eig ht out of ten progressors (80%) improved clinically. In patients with advanced coronary atherosclerosis and severe hypercholesterolemia HELP -therapy can safely and effectively lower LDL-C, Lp(a), and fibrinogen . The chronic weekly HELP-treatment results in clinical improvement in the majority of patients, even in those patients with angiographicall y shown CAD progression. (C) 1998 Elsevier Science Ireland Ltd. All ri ghts reserved.