Long-term lipoprotein apheresis in the treatment of severe familial hypercholesterolemia refractory to high intensity statin therapy: Three year experience at a lipoprotein apheresis centre
Background: Severe familial hypercholesterolemia (FH) individuals, refractory to conventional lipidloweringmedications are at exceptionally high risk of cardiovascular events. The established therapeuticoption of last choice is lipoprotein apheresis (LA). Herein, it was sought to investigate the clinical usefulnessof LA in a highly selected group of severe heterozygous FH (HeFH), as recently described by theInternational Atherosclerosis Society (IAS), for their efficacy in lipid reduction and safety.Methods: Efficacy and safety of LA were investigated in 318 sessions of 7 severe HeFH females withcardiovascular disease, over a mean period of 26.9 ± 6.5 months. Relative reduction of low density lipoproteincholesterol (LDL-C) ≥ 60%, clinical complications and vascular access problems were evaluatedand compared between the direct adsorption of lipoproteins (DALI) and lipoprotein filtration (MembraneFiltration Optimized Novel Extracorporeal Treatment [MONET]). Additionally, lipoprotein (a)[Lp(a)], total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) andfibrinogen concentrations were investigated.Results: The relative reduction of LDL-C, TC, TG and Lp(a) were 69.4 ± 12.9%, 59.7 ± 9.1, 51.5 ±± 14.2% and 71.3 ± 14.4%, respectively. A similar efficacy was found in both systems in LDL-C removal.DALI system led to larger depletions of Lp(a) (80.0 [76–83]% vs. 73.0 [64.7–78.8]%; p < 0.001).The frequency of clinical side effects and vascular access problems were low (8.5%).Conclusions: Long-term LA in severe HeFH individuals is safe and efficiently reduces LDL-C andLp(a). Higher efficacy of the DALI system than MONET in Lp(a) removal may indicate the need for individualizedapplication of the LA system in severe HeFH individuals
