Low-Density Lipoprotein Apheresis Versus Lipid Lowering Drugs in the Treatment of Severe Hypercholesterolemia: Four Years' Experience

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Abstract
Elevated lipoprotein concentrations seem to be linked strongly in a dose dependent manner to an increased incidence of atherosclerosis. A total of 47 patients suffering from severe hyperlipidemia were matched to treatment with LDL apheresis (Baxter, Kaneka, Lipopak; 24 patients, aged 50.2 + or - 11.5 years), diet, and/or lipid-lowering drugs or with diet and lipid-lowering drugs only (23 patients, aged 48.8 + or - 11.8 years). After treatment periods of 49.8 + or - 13.4 months (apheresis group, 2,396 treatment sessions) and 38.6 + or - 15.1 months (drug group), the ensuing results revealed significant differences (p < 0.0001): -47.3% versus -12.1% for total cholesterol, -46.9% versus -21.8% for LDL, +8.4% versus +0.9% for HDL, -52.0% versus -13.1% for the LDL/HDL ratio, -36.4% versus - 16.2% for triglycerides, and -25.9% versus + 1.5% for lipoprotein (a). In the apheresis group, one patient died of myocardial infarction; in the drug group, there was one nonfatal myocardial infarction and the manifestation of coronary heart disease in 3 cases. There were no severe side effects in either group. All patients in the apheresis group responded to therapy. The present trial suggests that a continuing reduction in serum lipid concentrations may lower, in a dose dependent manner, the risk for development and progression of coronary heart disease. Regarding clinical and laboratory results, LDL apheresis seems to be safe, effective therapy for treatment of severe hyperlipidemia.