Key result
H.E.L.P. lipid apheresis linked to a ~21% reduction in minimum coronary resistance, improving vasodilatation capacity.
Why the study?
Lipid apheresis effects on oxidative stress, rheology, and endothelial function in homozygous and therapy-resistant hypercholesterolemia were investigated.
Does lipid apheresis improve endothelial function and reduce oxidative stress in patients with severe hypercholesterolemia?
Observational (n=47)
Does lipid apheresis improve endothelial function and reduce oxidative stress in patients with severe hypercholesterolemia?
Absolute Event Rate: 0.44% vs 0.56%
p-value: p=<0.0001
Lipid apheresis rapidly improves endothelial function and reduces oxidative stress in patients with severe hypercholesterolemia or elevated Lp(a).
Case report links lipid apheresis to acute coronary vasodilation gains; hypothesis-generating and requires prospective trials before clinical consideration.
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 fibrinogen leads to an improvement in rheology and endothelial function, detectable and measurable within approximately 20 h by assessing minimum coronary resistance using positron 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 procedure 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 resistance, 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.
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Mellwig et al. (2012) conducted an observational in Hypercholesterolemia and coronary artery disease (n=47). Lipid apheresis (H.E.L.P. procedure) vs. Baseline (pre-apheresis) was evaluated on Minimum coronary resistance (mmHg min 100 g/ml) in chronically treated patients (p=<0.0001). Lipid apheresis using the H.E.L.P. procedure significantly reduced minimum coronary resistance from 0.56 to 0.44 mmHg min 100 g/ml, indicating improved coronary vasodilatation capacity.
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