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Low-density lipoprotein apheresis for the treatment of refractory hyperlipidemia
A Vella1, A A Pineda, T O'Brien
1Division of Endocrinology, Metabolism, Nutrition and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Insights
Low-density lipoprotein (LDL) apheresis offers an effective treatment for hypercholesterolemia, particularly for familial hypercholesterolemia (FH) patients unresponsive to statins. This therapy is also showing promise for other conditions like graft vascular disease.
Area of Science:
- Cardiovascular Medicine and Lipidology
- Nephrology
Background:
- Statins (3-hydroxy-3-methylglutaryl coenzyme A inhibitors) effectively manage hypercholesterolemia for most patients.
- Familial hypercholesterolemia (FH) and other conditions may necessitate advanced lipid-lowering therapies beyond diet and statins.
Purpose of the Study:
- To review the efficacy and emerging indications of low-density lipoprotein (LDL) apheresis in managing lipid disorders.
- To examine the evidence supporting LDL apheresis in clinical practice for specific patient populations.
Main Methods:
- Review of current clinical practice guidelines and available evidence for LDL apheresis.
- Analysis of treatment criteria based on LDL cholesterol levels for homozygous and heterozygous FH patients.
- Exploration of non-lipid disorder indications for LDL apheresis.
Main Results:
- LDL apheresis is an established treatment for FH patients with severe hypercholesterolemia, especially when medical therapy fails.
- Specific LDL cholesterol thresholds guide the initiation of LDL apheresis for FH patients.
- Emerging applications include treatment of graft vascular disease and certain glomerulonephritides.
Conclusions:
- LDL apheresis is a valuable therapeutic option for select patients with severe hypercholesterolemia and FH.
- The role of LDL apheresis is expanding to include non-lipid related conditions, demonstrating its versatility.
Abstract:
The advent of treatment with 3-hydroxy-3-methylglutaryl coenzyme A inhibitors has meant that, with a combination of diet and drug therapy, adequate control of serum cholesterol concentrations can be achieved in most patients with hypercholesterolemia. However, some patients, primarily those with familial hypercholesterolemia (FH), may require additional therapy to lower their cholesterol levels. In recent years, low-density lipoprotein (LDL) apheresis has emerged as an effective method of treatment in these patients. The criteria for commencement of LDL apheresis are LDL cholesterol levels of 500 mg/dL or higher for homozygous FH patients, 300 mg/dL or higher for heterozygous FH patients in whom medical therapy has failed, and 200 mg/dL or higher for heterozygous FH patients with documented coronary disease and in whom medical therapy has failed. In addition to cholesterol lowering in patients with FH, other indications for LDL apheresis are emerging. These include its use in the treatment of graft vascular disease in patients receiving cardiac transplants as well as in the treatment of certain glomerulonephritides. This review examines the role of LDL apheresis in the management of lipid disorders and the evidence available to support its use in clinical practice.