Low‐density Lipoprotein Apheresis: An Overview

Abstract

Atherosclerosis with myocardial infarction, stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial hypertension, diabetes mellitus, and central obesity. Furthermore, there is a strong correlation between hyperlipidemia and atherosclerosis. The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lpa) levels, and coronary heart disease (CHD) refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are four different LDL apheresis systems available: immunoadsorption, heparin-induced extracorporeal LDL/fibrinogen precipitation, dextran sulfate LDL adsorption and LDL hemoperfusion. Regarding the different LDL apheresis systems used, there is no significant difference with respect to the clinical outcome or concerning total cholesterol, LDL, high-density lipoprotein (HDL), or triglyceride concentrations. With respect to elevated Lpa levels, however, the immunoadsorption method seems to be the most effective. In 45 patients (25 women, 20 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low-density lipoprotein (LDL) apheresis was performed over 95.6 +/- 44.7 months. Four different systems (Liposorber, 32 of 45, Kaneka, Osaka, Japan; Therasorb, 6 of 45, Baxter, Munich, Germany; Lipopak, 2 of 45, Pocard, Moscow, Russia; and Dali, 5 of 45, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 57% for total cholesterol, 55.9% for LDL, 75.8% for lipoprotein a (Lpa), and 45.9% for triglycerides, and an average increase of 14.3% for HDL were reached. Severe side-effects such as shock or allergic reactions were very rare (0.3%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 44 of 45 patients. The present data demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe even in long-term application.

High lipoprotein (a) levels are associated with an increased risk of retinal vein occlusion

“…Some reports indicating the possible beneficial role of aspirin therapy in the management of RVO and high Lp(a) levels have been reported, but data are very limited [33]. Moreover, a possible beneficial effect of treatment with extracorporeal lipid-selective apheresis and niacin has been proposed in patients with a vascular occlusive clinical event and markedly elevated Lp(a) levels, thus possibly hypothesising a role for this technique also for RVO, even if data supporting this approach are limited [34].…”

Homozygous Familial Hypercholesterolemia: Case report and Review of Literature

“…On the other hand, patients with HoFH are often diagnosed early in childhood, do not respond well to medical therapy, and can progress rapidly to premature coronary artery disease. 17 Dietary fat including cholesterol and triglycerides are absorbed in the intestine and released in the blood stream as chylomicrons. These are least dense particles having very high proportion of triacylglycerides.…”

Nonpharmacologic Approaches for the Treatment of Hyperlipidemia

“…All 4 methods have been found to be equally efficacious and safe. 19 Indications LDL apheresis is an expensive procedure, and at present, its indications are limited. As per ATP III, LDL apheresis is indicated in all patients with homozygous FH.…”