Related Experiment Videos
[Reducing low density lipoprotein-cholesterol levels by apheresis]
Insights
For familial hypercholesterolemia patients resistant to diet and drugs, lipoprotein apheresis offers a vital treatment. This procedure effectively lowers LDL cholesterol and other atherogenic factors, improving patient outcomes.
Area of Science:
- Cardiology
- Metabolic Disorders
- Biochemistry
Context:
- Familial hypercholesterolemia (FH) presents a significant challenge, with many patients exhibiting resistance to conventional diet and pharmacotherapy.
- Approximately 20% of FH heterozygotes and a predominant number of homozygotes do not respond adequately to lipid-lowering treatments, even with multiple drugs.
Purpose:
- To review and analyze various lipoprotein apheresis procedures for managing lipid-lowering resistant familial hypercholesterolemia.
- To evaluate the selectivity, advantages, disadvantages, and costs associated with different apheresis techniques.
Summary:
- Lipoprotein apheresis is indicated for both absolute (homozygotes) and relative (heterozygotes) cases of FH.
- Combining apheresis with diet and drugs can achieve maximal low-density lipoprotein-cholesterol reduction (60-70%).
- Apheresis can also remove lipoprotein(a) and fibrinogen, improving hemorheological status.
Impact:
- Provides a crucial alternative treatment for patients with severe or drug-resistant hypercholesterolemia.
- Offers a method to reduce atherogenic factors beyond LDL-cholesterol, potentially mitigating cardiovascular risk.
- Aids clinicians in selecting the most appropriate and cost-effective apheresis strategy for individual patients.
Abstract:
The predominate number of homozygote familial hypercholesterolemic and approximately 20% of heterozygotes are resistant to low cholesterol diet and lipid lowering pharmacological treatment even in combination of 2 or more drugs. In such cases, the selective lipoprotein apheresis has become a promising alternative and indicated absolute (homozygotes) or relative (heterozygotes). The combination of low density lipoprotein apheresis, together with diet and drugs, should allow a maximal lowering of low density lipoprotein-cholesterol (-60-70%). Besides low density lipoprotein, various apheresis procedures may also eliminate other potentially atherogenic factors, such as lipoprotein(a) and fibrinogen and acutely improve the haemo-rheological status of the patient. The authors review several lipoprotein apheresis procedures with varying degrees of selectivity, those have and furthermore analysis the advantages and disadvantages and cost of each procedure.