RESUMO
OBJECTIVE AND METHODS: Dyslipidemia and oxidative stress are causally related to atherogenesis and cardiovascular disease. We assessed acute changes of systemic oxidative stress biomarkers in thirty-two patients undergoing regular apheresis using four different techniques: heparin-induced extracorporeal LDL precipitation (HELP), direct adsorption of lipoproteins (DALI), lipidfiltration (LF), and immunoadsorption of lipoproteins (IA). RESULTS: All apheresis procedures were similarly effective in lowering LDL cholesterol (-2.5+/-0.2 mmoL/L), oxidized LDL (-52.4+/-4.4 U/L), and levels of antioxLDL antibodies (-59.5+/-15.1 U/L). Among the LDL-apheresis methods investigated, only the DALI technique without prior separation of blood plasma led to a decline in leukocyte count (p=0.01 vs. LF post apheresis) and to decreased phagocyte oxidant-generating activity as evaluated by chemiluminescence. Moreover, DALI was followed by a smaller decrease of blood total antioxidant capacity than the other techniques (p<0.01 vs. HELP post apheresis). CONCLUSION: Together, our data suggest that compared with other common techniques, the DALI apheresis system is accompanied by the lowest systemic oxidative burden evoked by a single apheresis treatment.
Assuntos
Remoção de Componentes Sanguíneos/métodos , LDL-Colesterol/sangue , Hiperlipidemias/terapia , Lipoproteínas LDL/sangue , Estresse Oxidativo , Idoso , Análise de Variância , Biomarcadores/sangue , Remoção de Componentes Sanguíneos/efeitos adversos , Regulação para Baixo , Feminino , Humanos , Hiperlipidemias/sangue , Técnicas de Imunoadsorção , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
This article presents the generally accepted indications for LDL apheresis treatment. The available LDL apheresis methods differ with respect to acute relative reductions of LDL cholesterol; mean values after the LDL apheresis treatments are not different. Serum triglycerides, HDL-cholesterol, and lipoprotein(a) are also acutely reduced. Available LDL apheresis methods differ with respect to their impact on the coagulation system, on C-reactive protein and on leukocyte count. Cardiovascular events are clearly reduced by the LDL apheresis methods. There is an urgent need to prospectively compare the different LDL apheresis methods taking into account hard end points. The lower target values for LDL cholesterol suggested by international guidelines for high-risk patients will certainly require a more widespread use of LDL apheresis.
