LDL apheresis or PCSK9 inhibition? Sometimes we have to combine them

Abstract

This study presents the case of a female patient with severe heterozygous familial hypercholesterolemia. Despite the combined maximum dose oral treatment with rosuvastatin and ezetimibe, we found markedly elevated lipid parameters. Therefore, we indicated monthly selective low density lipoprotein (LDL) apheresis treatment using the Direct Adsorption of Lipoproteins system. After more than 2 years the lipid levels of the patients were still above the therapeutic goals. Finally, we completed the treatment by the inhibitor evolocumab biweekly. Further LDL cholesterol (LDL-C) reduction was achieved resulting in lipid parameters on goals. However, administration of evolocumab without LDL apheresis could not reduce the LDL-C below 2.5 mmol/L. We concluded that both LDL apheresis and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor treatments were effective and well tolerated. None of them alone would be enough to achieve lipid goals in this patient. However, the combination of these potent treatments may normalize the lipid levels and prevent cardiovascular complications