Related Experiment Video
Updated: Mar 1, 2026
Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Toward an international consensus-Integrating lipoprotein apheresis and new lipid-lowering drugs
Claudia Stefanutti1, Ulrich Julius2, Gerald F Watts3
1Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy.
Insights
Novel lipid-lowering drugs may enhance lipoprotein apheresis (LA) effectiveness, potentially reducing treatment frequency. However, more research is needed to confirm the safety and efficacy of combining these therapies for dyslipidemia management.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Technology
Background:
- Dyslipidemia management remains challenging, with many patients not achieving optimal lipid levels to reduce atherosclerotic cardiovascular disease (ASCVD) risk.
- Novel lipid-lowering agents are emerging, offering new therapeutic avenues.
- Lipoprotein apheresis (LA) effectively reduces atherogenic lipoproteins but is often intensive.
Purpose of the Study:
- To provide recommendations on combining novel lipid-lowering drugs with LA for dyslipidemia.
- To summarize current evidence on emerging drug classes (PCSK9 inhibitors, MTP inhibitors, HDL mimetics) in conjunction with LA.
- To update existing American Society for Apheresis guidelines.
Main Methods:
- Review and synthesis of available data on novel lipid-lowering drug classes.
- Evaluation of evidence for combination therapy with LA.
- Development of recommendations based on the latest scientific evidence.
Main Results:
- Novel agents like PCSK9 inhibitors and MTP inhibitors show potential to complement LA therapy.
- Limited data exist on the effectiveness and safety of combining most novel drugs with LA, except for specific indications like familial hypercholesterolemia.
- The combination may potentially reduce LA frequency or allow discontinuation in some patients.
Conclusions:
- Novel lipid-lowering agents hold promise for optimizing LA therapy in dyslipidemia.
- Further clinical studies are essential to establish the safety and efficacy of these combination therapies.
- An international registry is proposed to gather clinical experience and expand evidence for high-risk cardiovascular patients.
Background:
Despite advances in pharmacotherapy of lipid disorders, many dyslipidemic patients do not attain sufficient lipid lowering to mitigate risk of atherosclerotic cardiovascular disease. Several classes of novel lipid-lowering agents are being evaluated to reduce atherosclerotic cardiovascular disease risk. Lipoprotein apheresis (LA) is effective in acutely lowering the plasma concentrations of atherogenic lipoproteins including low-density lipoprotein cholesterol and lipoprotein(a), and novel lipid-lowering drugs may dampen the lipid rebound effect of LA, with the possibility that LA frequency may be decreased, in some cases even be discontinued.
Sources Of Material:
This document builds on current American Society for Apheresis guidelines and, for the first time, makes recommendations from summarized data of the emerging lipid-lowering drug classes (inhibitors of proprotein convertase subtilisin/kexin type 9 or microsomal triglyceride transfer protein, high-density lipoprotein mimetic), including the available evidence on combination therapy with LA with respect to the management of patients with dyslipidemia.
Abstract Of Findings:
Recommendations for different indications are given based on the latest evidence. However, except for lomitapide in homozygous familial hypercholesterolemia and alirocumab/evolocumab in heterozygous familial hypercholesterolemia subjects, limited data are available on the effectiveness and safety of combination therapy. More studies on combining LA with novel lipid-lowering drugs are needed.
Conclusion:
Novel lipid-lowering agents have potential to improve the performance of LA, but more evidence is needed. The Multidisciplinary International Group for Hemapheresis TherapY and Metabolic DIsturbances Contrast scientific society aims to establish an international registry of clinical experience on LA combination therapy to expand the evidence on this treatment in individuals at high cardiovascular disease risk.
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:26Atherosclerosis III: Management
01:24Lipid Absorption
These breakdown products bind with bile salts and lecithin to form micelles, which quickly pass between microvilli to come in close contact with the apical...
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:30Atherosclerosis I: Introduction
01:24Overview of Lipid Metabolism
Lipolysis: The Breakdown of Lipids:
Lipolysis is the process of breaking down lipids, particularly triglycerides, into glycerol and fatty acids. This process typically occurs in the adipose tissue and is triggered by various hormones, including glucagon and...