The HELP‐LDL‐apheresis multicentre study, an angiographically assessed trial on the role of LDL‐apheresis in the secondary prevention of coronary heart disease. II. Final evaluation of the effect of regular treatment on LDL‐cholesterol plasma concentrations and the course of coronary heart disease*

Abstract

Abstract. The efficacy of the heparin-induced extracorporeal LDL-precipitation (HELP)-apheresis procedure has been studied in an open prospective multicentre trial. After 2 years of regular weekly HELP-treatment the data from 39 of 51 patients could be evaluated according to the study criteria. Twelve of the initially recruited study patients were omitted from the evaluation either because of premature termination of the treatment or because they did not fulfil the exact guidelines of the study protocol. A mean of 2.83 1 plasma was regularly treated on average every 7.85 days. The mean pre-/post-apheresis LDLcholesterol levels decreased from 286/121 mgdl-' at the first HELP treatment to 203/77mgdl-l after 1 year and to 205/77mgdl-' after 2 years of regular apheresis; the corresponding values for fibrinogen were 314/144, 246/98 and 250/105 mgdl-', respectively. In contrast, the mean pre-/post-apheresis HDLcholesterol levels rose from 41/38 through 511 44mgdl-' after 1 year to 52/43mgdl-' after 2 years of treatment. The overall result was a normalization of the atherogenic index (LDL-/HDL-cholesterol ratio) from 6.9/3.2 to 4*0/1.9. The angiographies from 33 patients obtained before and after 2 years of regular treatment could be evaluated blindly using the cardiovascular angiography analysis system. The mean degree of stenosis of all segments decreased from (26.7%) segments, whereas 29/187 (15.5%) segments showed progression. In 108/187 (57.8%) segments the lesions were stable (< 8% deviation) over 2 years. We conclude that regular treatment with HELP-LDLapheresis is able to stabilize progressive atherosclerotic disease and to induce almost twice as much regression as progression of atherosclerotic lesions.

LDL Apheresis: An Effective and Safe Treatment for Refractory Hypercholesterolemia

“…None of the homozygotes showed progression and 4/7 showed regression. The HELP LDL Apheresis Multicenter Study (20) had little change and nine patients had progression. The German Multicenter LDL Apheresis Trial (2) was a four center, three year prospective trial of 32 patients with FH.…”

“…A few other plasma proteins precipitate to some extent with heparin, most notably fibrinogen. An anion exchange column removes the excess heparin, and the plasma is treated with bicarbonate dialysis and ultrafiltration to return the pH to normal (19,20). Dextran sulfate cellulose columns selectively bind apolipoprotein B containing lipoproteins based on a charge attraction (10,27).…”

Does Therapeutic Intervention Achieve Slowing of Progression or Bona Fide Regression of Atherosclerotic Lesions?

“…In the first major multicenter study, after 2 years of treatment, stenosis of coronary arteries improved by 8% in one fourth of arterial segments. 58 In a randomized study, FH heterozygotes with CAD received twice-weekly dextran-sulfate LDL apheresis plus simvastatin, or colestipol and simvastatin. 59 QCA was performed in 39 patients before and after 2 years of treatment.…”

Lipoprotein(a) - Structure, Epidemiology, Function and Diagnostics of a Cardiovascular Risk Marker

“…The procedures that are primarily developed for the removal of LDL allow a reduction of Lp(a) plasma concentrations by up to 80 %, depending on the volume of blood or plasma that is treated [2,[181][182][183].…”