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Low density lipoprotein apheresis in treatment of hyperlipidemia: experience with four different technologies
R Bambauer1, R Schiel, R Latza
1Institute for Blood Purification, Homburg/Saar, Germany.
Insights
Low-density lipoprotein (LDL) apheresis offers a safe and effective long-term treatment for severe hyperlipidaemia (HLP) and coronary heart disease (CHD) refractory to conventional therapies. This therapy significantly reduces lipid levels and improves patient well-being and performance.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Severe hyperlipidaemia (HLP) and coronary heart disease (CHD) refractory to conventional treatments present a poor prognosis.
- Elevated lipoprotein (a) levels can exacerbate cardiovascular risk in these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of low-density lipoprotein (LDL) apheresis as a therapeutic option for patients with severe HLP and CHD resistant to diet and lipid-lowering drugs.
- To compare the effectiveness of different LDL apheresis systems, particularly for elevated lipoprotein (a) levels.
Main Methods:
- A cohort of 33 patients with severe HLP and drug-refractory CHD underwent regular LDL apheresis for a mean duration of 62.3 months.
- Four different LDL apheresis systems were utilized: dextran sulfate adsorption, immunoadsorption, LDL-hemoperfusion, and immunoadsorption with anti-lipoprotein (a) columns.
- Clinical outcomes, lipid profiles (total cholesterol, LDL, HDL, triglycerides, Lp(a)), medication use, and side effects were monitored.
Main Results:
- LDL apheresis achieved significant reductions in total cholesterol (46%), LDL (49%), Lp(a) (28%), and triglycerides (38%) (p < 0.05).
- 29 of 33 patients reported improved well-being and increased performance.
- 23 of 27 CHD patients experienced a 60-100% reduction in nitrate medication.
- While all systems showed comparable lipid-lowering effects, immunoadsorption with anti-Lp(a) columns was most effective for reducing elevated Lp(a) levels (-57%).
- Severe side effects were rare (0.5%).
Conclusions:
- Long-term LDL apheresis is an effective and safe treatment for severe HLP and refractory CHD.
- The therapy leads to significant lipid reduction, symptom improvement, and decreased medication needs.
- Specific immunoadsorption systems demonstrate superior efficacy in managing elevated lipoprotein (a) levels.
Abstract:
The prognosis of patients suffering from severe hyperlipidaemia (HLP), sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease (CHD) refractory to diet and lipid lowering drugs is poor. A new therapeutic option for such patients is regular treatment with low density lipoprotein (LDL) apheresis. In total 33 patients (16 males, 17 female, aged 43.8+/-14.3 years), suffering from severe HLP resistant to diet and lipid lowering drugs, were treated for 62.3+/-21.3 (range, 1-113) months with LDL-apheresis. Four different LDL-apheresis systems were used: the dextran sulfate adsorption for 28 of 33 (Liposorber, Kaneka, Japan), immunoadsorption for 2 of 33 (Therasorb, Baxter, Germany), LDL-hemoperfusion for 2 of 33 (Dali, Fresenius, Germany), and the immunoadsorption system with special antilipoprotein (a) columns for 1 of 33 patients (Lipopak, Pocard, Russia). Before applying LDL-apheresis, 27 of 33 patients suffered from CHD with severe angina pectoris symptoms, a history of myocardial infarction or coronary artery venous bypass (CAVB). With LDL-apheresis, reductions (p < 0.05) of 46% for total cholesterol, 49% for LDL, 28% for Lp(a), and 38% for triglycerides were reached. Severe side-effects, such as shock or allergic reactions, were very rare (0.5%). In the course of treatment an improvement in general well-being and increased performance were experienced in 29 of 33 patients. In 23 of 27 patients suffering from CHD, a reduction of 60 to 100% of nitrate medication was observed. Regarding the different apheresis systems used, there were no significant differences with respect to the clinical outcome and concerning total cholesterol, LDL, HDL, and triglyceride concentrations. But, in respect to elevated lipoprotein (a) levels, the immunoadsorption method using special anti-lipoprotein (a) columns seems to be the most effective (-57% versus -25% [Kaneka, p < 0.05] or -23% [Baxter, p < 0.05]). The present data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe HLP, refractory to maximum conservative therapy, is effective and safe in long-term application.
