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Treatment of severe hyperlipidemia: six years' experience with low-density lipoprotein apheresis
R Bambauer1, R Schiel, R Latza
1University of Saarland, Homburg, Germany.
Insights
Low-density lipoprotein (LDL) apheresis effectively treats severe familial hypercholesterolemia resistant to other therapies. This safe, long-term treatment significantly improves patient well-being and reduces cardiovascular symptoms.
Area of Science:
- Cardiology
- Metabolic Disorders
- Medical Technology
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder causing high LDL cholesterol.
- Patients with FH resistant to diet and drugs often have progressive cardiovascular disease.
- Lipid-lowering drug efficacy is limited in some severe FH cases.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of low-density lipoprotein (LDL) apheresis in patients with severe familial hypercholesterolemia.
- To assess the impact of LDL apheresis on cardiovascular symptoms and medication requirements.
Main Methods:
- A cohort of 30 FH patients, resistant to conventional therapy, underwent LDL apheresis for up to 6.8 years.
- Three different apheresis systems were utilized: dextran sulfate adsorption, Baxter immunoadsorption, and Lipopak immunoadsorption.
- Cardiovascular status, lipid profiles, and medication use were monitored before and during treatment.
Main Results:
- LDL apheresis achieved significant reductions: 47% in total cholesterol, 49% in LDL, 26% in lipoprotein(a) [Lp(a)], and 40% in triglycerides.
- 27 out of 30 patients reported improved well-being and increased physical performance.
- 17 out of 23 patients with coronary heart disease experienced a 60-100% reduction in nitrate medication.
Conclusions:
- LDL apheresis is a highly effective and safe therapeutic option for severe familial hypercholesterolemia unresponsive to maximal conservative treatment.
- Long-term LDL apheresis can lead to substantial clinical improvements, including reduced cardiovascular symptoms and medication needs.
- The procedure demonstrates a favorable safety profile with very rare severe adverse events.
Abstract:
In total, 30 patients suffering from familial hypercholesterolemia, resistant to diet and lipid-lowering drugs, were treated for up to 6 years (3.6 + or - 1.6; range, 0.2-6.8 years) with low-density lipoprotein (LDL) apheresis. Three different systems were used; the dextran sulfate adsorption system (Kaneka) for 27 of 30 patients, the immunoadsorption system from Baxter for 2 of 30 patients, and the immunoadsorption system with special lipoprotein(a) (Lp[a]) columns from Lipopak for one patient. Prior to the LDL apheresis, 23 of 30 patients suffered from coronary heart disease. Twenty of 23 patients suffered intermittently from symptoms of angina, excertional dyspnea, and claudication. With LDL apheresis, reductions of 47% for total cholesterol, 49% for LDL, 26% for Lp(a), and 40% for triglycerides were reached. Severe side effects such as shock or allergic reactions were very rare (0.55%). In the course of treatment with LDL apheresis, an improvement in general well-being and increased performance were experienced in 27 of 30 patients. A reduction of nitrate medication between 60 and 100% was observed in 17 of 23 patients. The present data clearly demonstrate that treatment with LDL apheresis in patients suffering from severe familial hyperlipidemia, resistant to maximum conservative therapy, is very effective and safe even over long periods of time.