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Effect of HELP-LDL-Apheresis on Outcomes in Patients With Advanced Coronary
Atherosclerosis and Severe Hypercholesterolemia
Atheroslerosis
1998;139:401-409.
Jai-Wun Park, Mechthild Merz, Peter Braun.
The authors undertook a prospective, open, single center study in patients with
advanced coronary atherosclerosis who were resistant to treatment with lipid-lowering
drugs and/or suffered from elevated fibrinogen or Lp(a) levels. Their aim was to
assess the impact of aggressive lowering of LDL-C, fibrinogen, and Lp(a) with diet,
medication, and weekly heparin-induced apheresis therapy on clinical outcomes (death,
angina pectoris, exercise tolerance, and coronary status after 10 months of the
heparin-induced therapy; LDL-C, fibrinogen, and Lp(a) levels after long-term treatment
with the heparin-induced method).
The study consisted of 44 patients with advanced coronary artery disease (CAD) and
LDL-C exceeding 160 mg/dL despite therapy with diet and lipid-lowering medications.
In contrast to previous trials, this study included patients with left ventricular
ejection fraction <0.35 treated with ACE inhibitors. Improvement of clinical
status via the heparin-induced method was defined as an increase of exercise tolerance,
decrease of antianginal drug use, and/or decrease of angina pectoris severity and
frequency. Blood chemistries included measurement of total cholesterol, triglycerides,
HDL-C, LDL-C, Lp(a), and fibrinogen. Bicycle ergometry in the sitting position was
used as an exercise test. Coronary angiography was performed to monitor CAD status.
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LDL-apheresis (mean of 15.5 ± 9.5 months) resulted in mean per-treatment
percent reduction of total cholesterol (44.8 ± 8.7), LDL-C
(55.5 ± 8.6), Lp(a) (60.8 ± 10.2), and fibrinogen (53.8 ± 6.5). |
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Improvement in clinical status was found in 73% of patients, with 11% showing no
change and 16% demonstrating deterioration in clinical status. |
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Twenty-three (52%) patients reported less frequency and severity of angina pectoris,
with 17 patients (39%) reporting no change and four patients (9%) reporting an increase.
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Maximal workload as observed by bicycle ergometry testing increased significantly
from 101 ± 41 watts (W) to 119 ± 46 W (P<0.001) posttreatment. |
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Ten (40%) patients who underwent coronary angiography demonstrated CAD progression,
whereas two (8%) patients had CAD regression. Nonetheless, eight out of the 10 (80%)
progressors demonstrated clinical improvement. This apparent contradiction between
CAD progression and clinical improvement was believed to be due to the impact of
heparin-induced therapy on rheologic and antithrombotic mechanisms. |
The authors concluded that apheresis via the heparin-induced method can safely and
effectively lower LDL-C, Lp(a), and fibrinogen in patients with advanced coronary
atherosclerosis and severe hypercholesterolemia. Frequent treatments with the heparin-induced
method resulted in clinical improvement even in patients with angiographically-demonstrable
CAD progression.
Click for full abstract.
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