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J. Cardiovasc. Dev. Dis. 2018, 5(2), 27; https://doi.org/10.3390/jcdd5020027

Current Role of Lipoprotein Apheresis in the Treatment of High-Risk Patients

Lipidology and Center for Extracorporeal Treatment, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
Received: 30 March 2018 / Revised: 25 April 2018 / Accepted: 4 May 2018 / Published: 9 May 2018
(This article belongs to the Special Issue Lipoprotein Metabolism and Atherosclerosis)
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Abstract

Lipoprotein apheresis (LA) is a therapeutic approach to save the lives of patients who are at an extremely high risk of developing cardiovascular events (CVE), especially after all other therapeutic options were not tolerated, or appeared not to be effective enough. Homozygous familial hypercholesterolemia represents a clear indication to start LA therapy. Another recognized indication is a severe hypercholesterolemia, which induced CVE, often in association with other risk factors. In the last years, an expressive elevation of lipoprotein(a) (Lp(a)) emerged as an indication for LA. In Germany, progress of atherosclerosis should have been documented before the permission to start LA therapy is given in these patients. Usually, all LA methods acutely decrease both LDL-C and Lp(a). However, specific columns which reduce only Lp(a) are available. Case reports and prospective observations comparing the situation before and during LA therapy clearly show a high efficiency with respect to the reduction of CVE, especially in patients with high Lp(a) levels. PCSK9 inhibitors may reduce the need for LA in patients with heterozygous or polygenetic hypercholesterolemia, but in some patients, a combination of these drugs with LA will be necessary. In the future, an antisense oligonucleotide against apolipoprotein(a) may offer an alternative therapeutic approach. View Full-Text
Keywords: LDL-cholesterol; lipoprotein(a); triglycerides; cardiovascular events; lipoprotein apheresis; PCSK9 inhibitors; lomitapide; antisense oligonucleotide against apolipoprotein(a) LDL-cholesterol; lipoprotein(a); triglycerides; cardiovascular events; lipoprotein apheresis; PCSK9 inhibitors; lomitapide; antisense oligonucleotide against apolipoprotein(a)
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Julius, U. Current Role of Lipoprotein Apheresis in the Treatment of High-Risk Patients. J. Cardiovasc. Dev. Dis. 2018, 5, 27.

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