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Lipoprotein apheresis: present and future uses
1Atherosclerosis and Lipoprotein Apheresis Center, University of Kansas Medical Center, Kansas City, Kansas.
Insights
Lipoprotein apheresis effectively lowers LDL-C and vascular inflammation but may be less common for familial hypercholesterolemia due to new therapies. Its future lies in treating other vascular diseases.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Apheresis Therapy
Background:
- Lipoprotein apheresis has been a primary therapy for familial hypercholesterolemia (FH) patients with uncontrolled LDL-C and cardiovascular disease for 40 years.
- The emergence of novel lipid-modifying agents prompts a re-evaluation of lipoprotein apheresis's role.
Purpose of the Study:
- To review the current status and future implications of lipoprotein apheresis in light of advancements in lipid-lowering therapies.
- To explore potential new applications for lipoprotein apheresis beyond FH.
Main Methods:
- Review of existing literature on lipoprotein apheresis, lipid-modifying agents, and cardiovascular disease.
- Analysis of the impact of lipoprotein apheresis on plasma lipids, vascular inflammation, and blood rheology.
- Examination of regulatory approvals and clinical outcomes in various vascular conditions.
Main Results:
- Lipoprotein apheresis reduces apolipoprotein B lipoproteins, vascular inflammation, and improves blood rheology.
- Therapy has shown benefits in nephrotic syndrome and peripheral arterial disease, with FDA approval for focal segmental glomerulosclerosis.
- German approval exists for elevated lipoprotein(a) with cardiovascular disease, regardless of LDL-C levels.
Conclusions:
- New lipid-modifying therapies are expected to decrease the use of lipoprotein apheresis for FH.
- Future applications may focus on vascular diseases lacking effective treatments, where apheresis can improve outcomes by reducing lipids, inflammation, and improving rheology.
Purpose Of Review:
For the past 40 years, apheresis, in particular, lipoprotein apheresis, has been the therapy of choice to lower LDL-C for familial hypercholesterolemia patients with uncontrolled dyslipidemia and cardiovascular disease. With the advent of recent and future lipid-modifying agents and their ability to lower LDL-C, the question arises on what will be the future of lipoprotein apheresis.
Recent Findings:
Lipoprotein apheresis lowers not only plasma levels of apolipoprotein B lipoproteins but also markers of vascular inflammation and blood rheology. Other vascular diseases, not necessarily associated with familial hypercholesterolemia, such as nephrotic syndrome and peripheral arterial disease have profited from lipoprotein apheresis therapy. In 2013, the Food and Drug Administration approved lipoprotein apheresis therapy for patients with focal segmental glomerulosclerosis. Since 2010, the German healthcare ministry has approved lipoprotein apheresis therapy for patients with an elevated lipoprotein(a) and ongoing cardiovascular disease irrespective of LDL-C levels.
Summary:
Recent and future lipid-modifying therapies will most likely reduce the practice of lipoprotein apheresis therapy for familial hypercholesterolemia patients. Future implications for lipoprotein apheresis will involve vascular diseases that are at present lacking clinically effective therapy, whereas acute and chronic reductions of lipids, vascular inflammation, and/or rheology may improve the clinical outcome.
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