Related Experiment Videos
Current topics on low-density lipoprotein apheresis
R Bambauer1, R Schiel, R Latza
1Institute for Blood Purification, Homburg/Saar, Germany.
Insights
Low-density lipoprotein (LDL) apheresis is an effective treatment for severe hyperlipidemia and coronary heart disease (CHD) refractory to conventional therapies. Immunoadsorption shows particular efficacy for elevated lipoprotein (a) [Lp(a)] levels.
Area of Science:
- Cardiology
- Metabolic Disorders
- Vascular Medicine
Background:
- Severe hyperlipidemia (HLP) and elevated lipoprotein (a) [Lp(a)] levels, often with coronary heart disease (CHD), pose poor prognoses despite diet and lipid-lowering drugs.
- Atherosclerosis remains a leading cause of mortality, with hyperlipidemia as a key risk factor.
- Established risk factors include smoking, hypertension, diabetes, and obesity, highlighting the need for aggressive lipoprotein reduction.
Purpose of the Study:
- To evaluate the efficacy and safety of low-density lipoprotein (LDL) apheresis for patients with severe HLP and CHD unresponsive to maximal conventional therapy.
- To compare the effectiveness of different LDL apheresis systems, particularly concerning Lp(a) reduction.
Main Methods:
- Review of published data on four LDL apheresis systems: immunoadsorption, heparin-induced extracorporeal LDL/fibrinogen precipitation, dextran sulfate LDL-adsorption, and LDL-hemoperfusion.
- Analysis of clinical outcomes, including lipid profiles (total cholesterol, LDL, HDL, triglycerides) and Lp(a) levels.
Main Results:
- LDL apheresis is effective and safe for long-term treatment of severe HLP refractory to maximal conservative therapy.
- No significant differences were observed among LDL apheresis systems regarding overall clinical outcomes or standard lipid parameters.
- Immunoadsorption demonstrated superior effectiveness in reducing elevated Lp(a) levels.
Conclusions:
- LDL apheresis is a valuable therapeutic option for severe hyperlipidemia and associated CHD when standard treatments fail.
- The choice of apheresis system may be tailored, with immunoadsorption being preferred for patients with elevated Lp(a).
- Continued application of LDL apheresis offers a safe and effective strategy for managing refractory hyperlipidemia and reducing cardiovascular risk.
Abstract:
The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lp[a]) 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. Despite substantial progress in diagnostics, drug therapy, and cardiosurgical procedures, 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. Besides the elimination of other risk factors, in severe hyperlipidemia (HLP) therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, however, sometimes the goal of therapy cannot be reached. Mostly, the prognosis of patients suffering from severe HLP, sometimes combined with elevated Lp(a) levels and CHD refractory to diet and lipid-lowering drugs is poor. Hence, in such patients, treatment with LDL-apheresis can be useful. Regarding the different LDL-apheresis systems used, there were no significant differences with respect to the clinical outcome or concerning total cholesterol, LDL, high-density lipoprotein, or triglyceride concentrations. With respect to elevated Lp(a) levels, however, the immunoadsorption method seems to be the most effective. The published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application.