The German Multicenter LDL-Apheresis Trial showed that a partial regression of tendon xanthomas could be obtained applying LDL-apheresis without cholesterol lowering drug therapy over a period of 3 years, whereas secondary prevention of coronary heart disease was generally observed in the mainly heterozygous patients. As there were considerably fewer homozygous patients and the average age of the heterozygous patients in this study was higher compared to the phase I trial regression may well occur with this therapy although it appears to be restricted to young patients only. If the additional information obtained from continuation of the treatment these patients and from other patients under going regular LDL-apheresis for up to 16 years is also taken into consideration the assumption appears to be well supported that interventions such as a second PTCA or a second coronary bypass operation can be avoided. LDL-apheresis increases the quality of live by decreasing the frequency of angina pectoris and also--at least in homozygous patients--is able to prolong life expectancy to a considerable extent. However, additional risk factors may play a role and have to be taken into consideration.
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