Effectiveness of long-term heparin-indycecd extracorporeal LDL precipitation (HELP) in improving coronary calcifications

There is dear clinical evidence that a drastic lowering of plasma LDL- Cholesterol (LDL) concentrations significantly reduces the rate of total and coronary mortality as well as the Incidence of cardiovascular events in high risk hypercholesterolemic patients. We describe the case of a 51-year-old woman with coronary heart disease (CHD) who presented with increasing angina on exertion in 1995, at the age of 45, She suffered from a heterozygous familial hypercholesterolemia and in 1985 her total cholesterol (TCHO) was 328 plus or minus 62 mg/dl (mean value often analysis). After ten years of statins her mean values (20 analysis; 2 per year) were: TCHO 259 plus or minus 71, LDL 209 plus or minus 47, HDL 35 plus or minus 7 mg/dl. Coronary angiography (CA) performed in 1995 disclosed three vessel coronary heart disease with significant stenoses of the distal right coronary artery, multiple calcifications of the interventricularis artery and multiple plaques with significant stenoses in the ramus circumflexus, The woman underwent coronary by-pass surgery. Thereafter the patient was treated for six years with HELP in biweekly intervals, in combination with statins. TCHO, LDL, HDL and fibrinogen (fb) levels were measured before and after each treatment. Their mean values for an amount of 120 sessions were: TCHO pre 216 plus or minus 23, post 111 plus or minus 18 LDL pre 152 plus or minus 16 post 67 plus or minus 18, HDL pre 42 plus or minus 5 post 35 plus or minus 4 fb pre 306 plus or minus 48 post 125 plus or minus 31. In 2001 a new CA was performed. Calcifications disappeared and stenoses were identical to the previous CA or reduced. There were no further clinical manifestations of CHD. We trust that the clinical benefit of the HELP procedure will be substantial for those patients who have problems in clearing LDL from their plasma pool and who are at the same time sensitive to elevated LDL levels by the development of premature coronary sclerosis.