LDL-apheresis is a method for the extracorporeal removal of LDL-cholesterol and its modified forms in patients with refractory hypercholesterolemia, who are unresponsive towards standard lipid lowering diets as well as drugs. The aim of this study was to analyse the influence of LDL apheresis on blood lipid profile and plasma fibrinogen concentration changes in patients with ischemic heart disease and refractory hypercholesterolemia. The study group comprised six men, aged between 39-54 who underwent coronary angiography and invasive treatment (3-PTCA, 3-CABG). The patients mean total cholesterol level was 7.7 mmol/l and the mean LDL-cholesterol level was 5.7 mmol/l despite a diet and one months treatment with simvastatine (20- 40mg/day). The mean plasma fibrinogen level prior to apheresis was 3.7g/l. Treatment with LDL-apheresis was introduced, two days before the revascularization procedure and continued for a period of one to three months following PTCA or CABG, in order to maintain the LDL-cholesterol level below 2.5 mmol/l. Results: A single LDL apheresis caused reduction of the mean total cholesterol level by 53% and mean LDL-cholesterol level by 65%. Examination of the LDL fraction revealed an increase of resistance towards oxidation performed ex vivo. We also observed a transient decrease in the mean plasma fibrinogen level (by 21%). Conclusions: LDL apheresis is a safe and effective method in the treatment of refractory hypercholesterolemia. Continued therapy with LDL-apheresis decreases coronary artery disease risk factors such as hypercholesterolemia and hyperfibrinogenemia.

Keywords: LDL-apheresis, refractory hypercholesterolemia