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Safety and effectiveness of long-term LDL-apheresis in patients at high risk
1Institute of Clinical Chemistry, University Hospital Grosshadern, Munich, Germany.
Insights
Low-density lipoprotein (LDL) apheresis effectively treats high-risk cardiovascular patients and heart transplant recipients. This therapy reduces cardiovascular events, improves survival, and enhances blood vessel function.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Transplantation
Background:
- Low-density lipoprotein (LDL) apheresis is a valuable treatment for patients unresponsive to diet and drugs.
- High prevalence of hypercholesterolemia and hyperfibrinogenemia impacts survival in heart transplant recipients.
- LDL apheresis demonstrates clinical utility in managing cardiovascular risk.
Purpose of the Study:
- To evaluate the efficacy of LDL apheresis in high-risk coronary patients and heart transplant recipients.
- To explore the mechanisms behind LDL apheresis's benefits, including simultaneous removal of atherogenic lipoproteins and improved endothelial function.
- To assess the impact of LDL apheresis on cardiovascular events, survival, and vasomotion.
Main Methods:
- Review of clinical studies on LDL apheresis in coronary artery disease and heart transplantation.
- Analysis of heparin-mediated extracorporeal LDL precipitation-LDL apheresis in heart transplant recipients.
- Examination of LDL apheresis's effects on LDL oxidation and endothelial-mediated vasomotion.
Main Results:
- Regular LDL apheresis favorably influences coronary artery disease progression and reduces cardiovascular events.
- Heparin-mediated extracorporeal LDL precipitation-LDL apheresis is successful in heart transplant recipients due to simultaneous removal of LDL, lipoprotein (a), and fibrinogen.
- LDL apheresis decreases LDL susceptibility to oxidation and rapidly improves endothelial-mediated vasomotion.
Conclusions:
- LDL apheresis is a clinically useful therapy for high-risk cardiovascular patients and heart transplant recipients.
- The simultaneous removal of atherogenic particles and improved vasomotion contribute to LDL apheresis's benefits.
- Further attention to system-specific differences and side effects is needed for routine clinical application.
Abstract:
Since its introduction more than 10 years ago, LDL-apheresis has gained much interest and has proven its clinical utility in patients who cannot be adequately treated by diet and drug therapy alone. A number of clinical studies have clearly demonstrated that regular LDL-apheresis not only favourably influences the progression of coronary artery disease, but also decreases the incidence of cardiovascular events and prolongs survival time of coronary patients at high risk. Both hypercholesterolemia and hyperfibrinogenemia show a high prevalence in heart transplant recipients and seem to cause direct effects on survival time. Heparin-mediated extracorporeal LDL-precipitation-LDL-apheresis has proven to be very successful in this group of patients, which may be caused by the simultaneous removal of LDL, lipoprotein (a) and fibrinogen, and also because LDL-apheresis decreases the susceptibility of LDL to oxidation. In addition, there is clear clinical and experimental evidence that LDL-apheresis rapidly improves the endothelial-mediated vasomotion. Not unexpectedly, there are differences in specificity and side-effects between the systems used and these deserve more attention for future routine clinical use.