Abstract

Abstract In  the  treatment  of  homozygous  and  therapy-resistant hypercholesterolemia,  lipid  apheresis  enables not only  low  density  lipoprotein  (LDL)  cholesterol  to  be lowered by  approximately  60%,  but  also  oxidative  stress factors to  be  influenced  and  adhesion molecules  reduced. This was  investigated  in  a  group  of  12  patients  using the heparin-induced  extracorporeal  LDL  precipitation (H.E.L.P.)  procedure. A significant  lowering of LDL cholesterol  and fibrino-gen leads  to  an  improvement  in  rheology  and  endothelial function,  detectable  and measurable within  approximately 20 h by assessing minimum coronary resistance using posi-tron emission tomography (PET)  performed in 35 patients. This effect is detectable even after the first lipid apheresis session (H.E.L.P. procedure),  documented in 12 patients. Lipid apheresis appears to be the most effective proce-dure in  the  treatment of elevated  lipoprotein(a)  [Lp(a)]. A chosen group of nine patients with selective elevated Lp(a) illustrated both the influence on endothelial dysfunction,  in the shape  of  sharply  increased minimum  coronary  resist-ance,  and the reduction through lipid apheresis,  indicating that Lp(a)  seems  to  exert  a  similar  effect  on  the  vascular wall and vascular function as LDL cholesterol.