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Coronary Artery Disease: Research and Practice
Coronary Artery Disease: Research and Practice
iConcept Press

Chapter 1

Coronary Artery Disease: Research and Practice

LDL- and Lipoprotein (a) - Apheresis in Hypercholesterolemia and Coronary Artery Diseases

by Rolf Bambuer, Daniel Burgard, Reinhard Latza and Ralf Schiel

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Numerous epidemiological investigations have shown the importance of cholesterol, and in particular low density lipoprotein (LDL), and of the lipoproteins in the development of coronary sclerosis. A continuing relationship between cholesterol levels and coronary morbidity has been established. The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lp(a)) levels and coronary artery disease (CAD) refractory to diet and lipid-lowering drugs is poor. There is a strong correlation between hyperlipidemia and atherosclerosis. Lp(a) is a risk factor for premature cardiovascular and cerebrovascular diseases, and can be lowered by LDL-apheresis. Especially in isolated high levels of Lp(a) with CAD or polygenic hypercholesterolemia with elevated Lp(a) levels, LDL-apheresis can be indicated and can be useful to improve endothelium regulation and induce changes in coronary tone by an increase in endothelial derived relaxing factor. LDL, Lp(a), and other lipids can be dramatically lowered by LDL-apheresis. Today, there are five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. Besides the elimination of other risk, in severe hyperlipidemia therapeutic strategies should focus on a drastric reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. Wirh respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term.

Author Details

Rolf Bambuer
Institute for Blood Purification, University of Saarland, Homburg, Germany
Daniel Burgard
Heart Cewnter Duisburg, Duisburg, Germany
Reinhard Latza
Laboratorimu of Medicine, St.Ingbert, Germany
Ralf Schiel
Inselklinik Heringsdorf GmbH, Seeheilbad Heringsdorf, Germany


Rolf Bambuer, Daniel Burgard, Reinhard Latza and Ralf Schiel. LDL- and Lipoprotein (a) - Apheresis in Hypercholesterolemia and Coronary Artery Diseases. In Coronary Artery Disease: Research and Practice. ISBN:978-1-922227-98-0. iConcept Press. 2016.