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LDL apheresis.

Gilbert R Thompson1

  • 1Metabolic Medicine, Division of Investigative Sciences, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 ONN, United Kingdom. g.thompson@ic.ac.uk

Atherosclerosis
|March 6, 2003
PubMed
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Low density lipoprotein (LDL) apheresis effectively treats familial hypercholesterolaemia (FH) and severe dyslipidaemia. This safe procedure lowers LDL cholesterol and Lp(a) without significantly reducing HDL cholesterol.

Area of Science:

  • Cardiology
  • Biochemistry
  • Medical Technology

Background:

  • Familial hypercholesterolaemia (FH) and severe dyslipidaemia pose significant cardiovascular risks.
  • Patients refractory to or intolerant of lipid-lowering drugs require alternative treatment options.
  • Low density lipoprotein (LDL) apheresis is an established therapeutic modality.

Purpose of the Study:

  • To review the efficacy and applications of LDL apheresis.
  • To compare different LDL apheresis methods.
  • To discuss current limitations and potential future indications for LDL apheresis.

Main Methods:

  • Established methods include adsorption via affinity columns (anti-apolipoprotein B, dextran sulphate) or heparin precipitation, requiring plasma separation.
  • A newer method allows direct adsorption from whole blood using polyacrylate columns.

Related Experiment Videos

  • All methods are employed weekly or biweekly.

    • Main Results:

    • All four LDL apheresis methods demonstrate similar efficiency in lowering LDL cholesterol and Lp(a).
    • These methods do not significantly reduce high density lipoprotein (HDL) cholesterol levels.
    • LDL apheresis is proven effective for homozygous FH and selected severe dyslipidaemia cases.

    Conclusions:

    • LDL apheresis is a safe and effective treatment for homozygous FH and severe dyslipidaemia unresponsive to conventional therapy.
    • Economic factors currently limit its use to life-threatening conditions.
    • Further controlled trials are needed to support expanded indications, such as in nephrotic syndrome, post-transplant vasculopathy, stroke, and post-angioplasty restenosis.