Long-term reduction of C-reactive protein concentration by regular LDL apheresis.
BACKGROUND
Increased C-reactive protein (CRP) concentration is an independent risk predictor for coronary heart disease (CHD). A therapeutic reduction of CRP might, therefore, reduce the risk of cardiovascular events. A single LDL apheresis lowers LDL cholesterol by 45-70%, and CRP by 20-65%, however, less is known about the long-term effects of LDL apheresis on CRP levels.


METHODS
We investigated 34 CHD patients (20 males, 14 females, 52 +/- 10 years) on statin therapy who were regularly treated by LDL apheresis because of drug-resistant hypercholesterolemia. Measurements of CRP (ultrasensitive nephelometric assay) were performed before the first apheresis, before a current apheresis (1 or 2 weeks after the last apheresis), and after a current apheresis (treatment period: 5.3 +/- 4.2 years, range: 0.25-12.5 years). LDL apheresis was performed by immunoadsorption (n = 6), dextran sulfate adsorption (n = 13), heparin-induced extracorporal LDL precipitation (HELP, n = 9), or direct adsorption of lipoproteins (DALI, n = 6).


RESULTS
CRP was significantly lower before a current apheresis (median: 0.75 mg/l, range: 0.16-4.33 mg/l) compared to before the first apheresis (median: 0.85 mg/l, range: 0.16-7.02 mg/l; P < 0.05). As expected, total and LDL cholesterol were lower before a current apheresis compared to before the initial apheresis while fibrinogen concentration did not differ significantly.


CONCLUSIONS
Over the period of more than 5 years LDL apheresis slightly, but significantly reduced CRP concentrations in patients with CHD on statin therapy, which may contribute to the stabilization of atherosclerosis in hypercholesterolemic patients treated with LDL apheresis. These results are even more impressive when the known age-related increase in CRP over the treatment period is taken into account.
Otto
Carsten
C
Medical Department 2-Grosshadern, University of Munich, Marchioninistrasse 15, D-81377 Munich, Germany. carsten.otto@med.uni-muenchen.de
Geiss
H Christian
HC
Empen
Klaus
K
Parhofer
Klaus G
KG
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D008078:Cholesterol, LDL / Q000378:metabolism; D003327:Coronary Disease / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D002097:C-Reactive Protein