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LDL apheresis in Japan.

Hisashi Makino1, Tamiko Tamanaha1, Mariko Harada-Shiba2

  • 1Division of Atherosclerosis and Diabetes, National Cerebral and Cardiovascular Center, Japan.

Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis
|October 2, 2017
PubMed
Summary

Early LDL apheresis is crucial for homozygous familial hypercholesterolemia (HoFH) patients for better outcomes. High-risk heterozygous FH (HeFH) patients also benefit from continued LDL apheresis therapy.

Keywords:
AtherosclerosisFamilial hypercholesterolemiaPeripheral artery disease

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Area of Science:

  • Cardiology
  • Metabolic Disorders
  • Vascular Medicine

Background:

  • Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol.
  • LDL apheresis is an established treatment for refractory FH, with selective LDL adsorption being common in Japan.
  • Emerging lipid-lowering therapies may alter future indications for LDL apheresis.

Purpose of the Study:

  • To evaluate the long-term prognosis of homozygous FH (HoFH) and heterozygous FH (HeFH) patients undergoing LDL apheresis.
  • To assess the efficacy of LDL apheresis in patients with severe atherosclerotic diseases, including peripheral artery disease (PAD).

Main Methods:

  • Observational study analyzing patient data on LDL apheresis initiation and continuation.
  • Comparison of outcomes between different age groups for HoFH and between continued vs. discontinued therapy for HeFH.
  • Inclusion of PAD patients with insufficient response to other treatments.

Main Results:

  • HoFH patients starting LDL apheresis in childhood had a better prognosis than those starting in adulthood.
  • HeFH patients who discontinued LDL apheresis showed a poorer prognosis compared to those who continued therapy.
  • LDL apheresis provided symptomatic relief for PAD patients unresponsive to other interventions.

Conclusions:

  • Early initiation of LDL apheresis in childhood is recommended for HoFH patients.
  • High-risk HeFH patients may require continued LDL apheresis even with controlled LDL-C levels.
  • LDL apheresis remains a valuable therapeutic option for severe atherosclerotic diseases in Japan.