[Maximal therapy of hypercholesterolemia in coronary heart disease].
Extracorporeal procedures to eliminate LDL from plasma now allow us to drastically lower the plasma LDL-concentrations to virtually every desired level. In a new therapeutic approach the combination of HMG-CoA reductase inhibitors with an LDL/fibrinogen apheresis procedure (the HELP-system) was evaluated in hypercholesterolemic CAD-patients. HELP treatment alone can lower the mean plasma LDL-cholesterol by about 50-60%, HMG-CoA reductase inhibitor therapy reduces the LDL-cholesterol by about 40%. The combination of both treatments resulted in a lowering of mean LDL-cholesterol to about 80% of baseline values. Improvement of blood rheology by lowering plasma viscosity and inhibiting erythrocyte aggregation became apparent. No relevant adverse effects were noted over a period of two years. This therapeutic strategy for maximal LDL-cholesterol lowering may be useful in secondary prevention of coronary heart disease in hypercholesterolemic patients if plasma LDL-C cannot be reduced by diet and drug treatment to desirable plasma levels (LDL-cholesterol less than 120 mg/dl). Preliminary data show an improvement in the symptoms of our CAD-patients treated with this combined therapy. Furthermore, within the near future a combined HELP and dialysis unit will be available for patients with terminal renal insufficiency and progressive atherosclerosis.
Thiery
J
J
Institut für Klinische Chemie, Ludwig-Maximilians-Universität, München.
Armstrong
V
V
Bosch
T
T
Eisenhauer
T
T
Schuff-Werner
P
P
Seidel
D
D
D000328:Adult; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001781:Blood Component Removal; D008078:Cholesterol, LDL / Q000097:blood; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000150:complications* / Q000517:prevention & control; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006937:Hypercholesterolemia / Q000150:complications / Q000628:therapy*; D008148:Lovastatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D019821:Simvastatin
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D004791:Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008148:Lovastatin; D019821:Simvastatin
Maximaltherapie der Hypercholesterinämie bei koronarer Herzerkrankung.