The use of lipoprotein apheresis for the treatment of high-risk patients with elevated lipoprotein(a) and hypercholesterolemia

Abstract

Aim: To assess the safety and efficiency of H.E.L.P.-apheresis and cascade lipid-filtration in the treatment of severe lipid disorders in high-risk patients. Methods: From 2016 to 2018 we observed 6 patients hyperLDLemia and high Lp(a)emia (> 60 mg/dL). The first group with H.E.L.P.-apheresis (n = 74 sessions) included 3 patients who underwent revascularization (coronary, femoral arteries). In the second group with cascade lipid-filtration (n = 92 sessions)-one patients underwent revascularization, two patients received drug therapy. Despite the lipid-lowering conventional therapy, no targeted low density lipoprotein (LDL) was obtained. Results: The patients of the 1st group had threefold decrease of LDL, in patients of the 2nd group LDL decreased by 68%. At the same time, in both groups, we noted a decrease in Lp(a) after the procedure by 65%-68%. Despite a decrease in high density lipoprotein (by 22%-29%) after lipid apheresis procedures, there was a positive trend in apoB100/apoA index (a decrease of 33% after HELP-apheresis procedures and 60% after cascade lipid-filtration) and a decrease in atherogenic index (38% and 53%, respectively). The changes in hematological and haemostatic parameters remained within physiological intervals. Conclusion: We noticed the successful application of lipid apheresis in patients with multifocal atherosclerosis and its complications.

ApoB100 and Atherosclerosis: What’s New in the 21st Century?

“…Both groups demonstrated a positive trend in the ApoB100/ApoA ratio (with a decrease of 33-60%) and a reduction in the atherogenic index (38% and 53%, respectively). Notably, ApoB100 levels were decreased by 54% in the H.E.L.P.-apheresis group and by 70% in the cascade lipid-filtration group [141]. However, a notable drawback of this method is the rebound phenomenon observed, as LDL-C and Lp(a) concentrations return to baseline levels within almost two weeks after its utilization [140].…”