Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the...

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Metabolic Disorders

Background:

• Persistent hypercholesterolemia requires nonpharmacologic therapy in some high-risk patients.
• Lipoprotein apheresis (LA) is an underused adjunctive treatment for lowering LDL cholesterol and lipoprotein(a).
• LA is indicated for familial hypercholesterolemia in children and adults.

Purpose of the Study:

• To review the history, mechanisms, and outcomes of lipoprotein apheresis.
• To discuss current indications and treatment options for LA.
• To highlight the underutilization of LA despite evidence of cardiovascular benefits.

Main Methods:

• Review of observational studies and scientific literature on lipoprotein apheresis.
• Analysis of data on cardiovascular and renal outcomes associated with LA.
• Examination of LA's effects beyond lipid lowering, including inflammation and endothelial function.

Main Results:

• LA effectively lowers LDL cholesterol and lipoprotein(a).
• LA demonstrates beneficial effects on cardiovascular outcomes, endothelial function, and microvascular perfusion.
• Evidence suggests potential benefits for refractory focal segmental glomerulosclerosis, though data are limited.
• LA use in the US is below its FDA-approved indications.

Conclusions:

• Lipoprotein apheresis is a valuable therapy for specific patient populations, including those with familial hypercholesterolemia.
• Further research and increased utilization are warranted given the demonstrated cardiovascular benefits.
• LA's role in managing refractory focal segmental glomerulosclerosis requires additional investigation.