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LDL Apheresis and Lp (a) Apheresis: A Clinician's Perspective
1Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Turkey. meral.kayikcioglu@gmail.com.
Insights
Lipoprotein apheresis is effective but challenging. This review discusses its indications and drawbacks, highlighting the need for better management strategies and new lipid-lowering agents.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
Background:
- Lipoprotein apheresis is a potent lipid-lowering therapy.
- Current management lacks specific guidelines, leading to variable patient adherence and suboptimal outcomes.
Purpose of the Study:
- To review clinical indications for lipoprotein apheresis.
- To discuss the significant drawbacks of this therapy based on recent evidence.
Main Methods:
- Literature review of recent evidence on lipoprotein apheresis.
- Analysis of clinical indications, efficacy, and patient adherence.
Main Results:
- Apheresis is most effective when initiated early and performed frequently.
- Clinical practice shows frequent failure to reach lipid targets due to late diagnosis, delayed referral, and low adherence.
- The therapy's invasive nature, time commitment, and impact on quality of life contribute to poor adherence and mental health issues.
Conclusions:
- Standardized protocols and regular cardiovascular follow-up are essential for effective lipoprotein apheresis.
- Integrating new lipid-lowering agents into treatment algorithms is crucial to overcome current limitations.
Purpose Of Review:
Lipoprotein apheresis is the most effective means of lipid-lowering therapy. However, it's a semi-invasive, time consuming, and chronic therapy with variable adherence. There are still no specific guideline recommendations for the management of patients on lipid apheresis. The purpose of this review is to discuss the clinical indications and major drawbacks of lipid apheresis in the light of recent evidence.
Recent Findings:
Lipoprotein apheresis should be initiated at early ages and performed frequently to receive the expected cardiovascular benefits. However, in clinical practice, most patients experience ineffective apheresis and fail to reach lipid targets. This real-world failure is due to several factors including late diagnosis, delayed referral, and improper frequency of procedures. All these denote that awareness is still low among physicians. Another important factor is the semi-invasive, time consuming nature of the apheresis, leading to high refusal and low adherence rates. Moreover, apheresis decreases quality of life and increases the risk of depression. Mental status is also deteriorated in patients with familial hypercholesterolemia on lipid apheresis. New effective lipid lowering agents are underway with promising cardiovascular results. To overcome the drawbacks, a structured approach, including standardized protocols for lipoprotein apheresis with regular cardiovascular follow-up is warranted. New effective lipid lowering agents with documented cardiovascular benefit, should be integrated into the treatment algorithms of patients on lipoprotein apheresis.
