REVIEW – August 2006

LDL apheresis in treatment of severe hypercholesterolemia


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The aim of the paper is to review low-density lipoprotein (LDL) apheresis as an effective method in treating patients with familial hypercholesterolemia to prevent the progression of coronary artery disease. LDL apheresis is a last-resort treatment for hypercholesterolemic patients resistant to lipid-lowering pharmacotherapy. The clinical effects of LDL apheresis comprise improvement of angina, exercise tolerance, reduction of clinical coronary events like unstable angina, need for coronary angioplasty or bypass operation, myocardial infarction and coronary mortality. The first LDL apheresis in Estonia was performed by Dr. Margus Viigimaa, Dr. Reet Välkmann, nurses Maris Piilberg and Triin Ladva on April 17, 2003 at the Department of Cardiology, Tartu University Hospital. We have used direct adsorbtion of lipoprotein using the hemoperfusion (DALI) technique of LDL apheresis. Ten procedures in three patients have been performed until now. There was an average dramatic decrease in cholesterol of 72.5% following treatment procedures. In our patients, adverse effects were uncommon and did not result in shortened treatment time. Our data support the use of LDL apheresis in Estonia in patients with severe hypercholesterolemia