Low-density lipoprotein apheresis as a treatment option for hyperlipidemia

Abstract

Data support the relevance of blood cholesterol levels, particularly high levels of low-density lipoprotein (LDL), in the pathogenesis and progression of atherosclerosis. A strong and continuous relationship between dyslipidemia and vascular morbidity and mortality has been established. The initial approach to treating dyslipidemia consists of lifestyle modifications followed by pharmacologic therapy, usually beginning with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor. Some patients with familial hypercholesterolemia (FH) fail to achieve their LDL goal despite aggressive pharmacologic therapy. In certain cases, LDL apheresis may be an effective therapeutic option. In the United States, LDL apheresis is approved for homozygous FH patients with an LDL cholesterol level >/= 500 mg/dL. For patients with heterozygous FH, LDL apheresis may be offered if their LDL is >/= 300 mg/dL, or >/= 200 mg/dL with known coronary artery disease, despite maximum medical treatment. This review focuses on the principles and methods of LDL apheresis, its potential benefit in clinical care, and its current indications.

Management of familial hypercholesterolemia during pregnancy: Case series and discussion

“…6 In individuals with heterozygote FH, LDL apheresis has been approved in the United States for primary prevention of coronary artery disease in individuals with LDL-C $300 mg/dL despite maximal dietary and drug intervention and for secondary prevention in those with LDL-C $ 200 mg/dL. 17 Randomized trials of CVD risk reduction with the use of apheresis in this population is, however, lacking. None of the women in our series had prepregnancy LDL-C levels $300 mg/dL on maximal dietary and drug treatment.…”

Low-density lipoprotein (LDL) apheresis reduces atherogenic and oxidative markers in uremic patients with hyperlipidemia

“…The LDLseparated plasma is then infused back to the patient. Thus, LDL apheresis removes from blood macromolecules like protein-bound MG, dityrosine, ox-LDL, Lp(a), and LDL [10,11]. On the other hand, the removal of macro-biomolecules by LDL apheresis is non-selective, and therefore, some ''good'' proteins will be partially removed by LDL apheresis as well.…”

Familial hypercholesterolemia: A review

“…Details on the techniques are beyond the scope of this update and interested readers may consult excellent reviews available on the subject. [737475]…”