Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection

Ulrich Julius Lipidology and Center for Extracorporeal Therapy, Department for Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany Abstract: This review reports the current situation with respect to therapeutic options (lifest...

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Autor principal: Julius U
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Publicado: Dove Medical Press 2016
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spelling oai:doaj.org-article:a01e4e57bb044ec1a5a1779e2a6f6a582021-12-02T01:38:42ZLipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection1179-1470https://doaj.org/article/a01e4e57bb044ec1a5a1779e2a6f6a582016-10-01T00:00:00Zhttps://www.dovepress.com/lipoprotein-apheresis-in-the-management-of-severe-hypercholesterolemia-peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Ulrich Julius Lipidology and Center for Extracorporeal Therapy, Department for Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany Abstract: This review reports the current situation with respect to therapeutic options (lifestyle and drugs) reducing the concentrations of atherogenic low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp[a]). Three lipoprotein apheresis (LA) principles have been realized: precipitation, filtration, and adsorption. Available LA methods are herein described in detail – major components, pumps, extracorporeal volume, treated volume, and anticoagulation. General features of all LA methods as well as pleotropic effects are elaborated. Indications for LA therapy are quoted: homozygous familial hypercholesterolemia (HCH), severe HCH, and isolated elevation of Lp(a) and progress of atherosclerotic disease. A major focus is on the evidence of the effect of LA on cardiovascular outcome data, and the most important publications are cited in this context. The best studies have been performed in patients with elevated Lp(a) in whom cardiovascular events were reduced by more than 80%. Major adverse effects and contraindications are listed. The impact of an LA therapy on patient quality of life and the requirements they have to fulfill are also highlighted. Finally, the future role of LA in treating high-risk patients with high LDL-C and/or high Lp(a) is discussed. It is probable that the significance of LA for treating patients with elevated LDL-C will decrease (with the exception of homozygous familial HCH) due to the application of PCSK9 inhibitors. The antisense oligonucleotide against apolipoprotein(a) could replace LA in patients with high Lp(a), provided positive outcome data are generated. Keywords: LDL cholesterol, lipoprotein(a), lipid-lowering therapy, lipoprotein apheresis, cardiovascular outcomeJulius UDove Medical PressarticleLDL cholesterolLipoprotein(a)lipid-lowering therapylipoprotein apheresiscardiovascular outcomeMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol Volume 9, Pp 349-360 (2016)
institution DOAJ
collection DOAJ
language EN
topic LDL cholesterol
Lipoprotein(a)
lipid-lowering therapy
lipoprotein apheresis
cardiovascular outcome
Medical technology
R855-855.5
spellingShingle LDL cholesterol
Lipoprotein(a)
lipid-lowering therapy
lipoprotein apheresis
cardiovascular outcome
Medical technology
R855-855.5
Julius U
Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection
description Ulrich Julius Lipidology and Center for Extracorporeal Therapy, Department for Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany Abstract: This review reports the current situation with respect to therapeutic options (lifestyle and drugs) reducing the concentrations of atherogenic low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp[a]). Three lipoprotein apheresis (LA) principles have been realized: precipitation, filtration, and adsorption. Available LA methods are herein described in detail – major components, pumps, extracorporeal volume, treated volume, and anticoagulation. General features of all LA methods as well as pleotropic effects are elaborated. Indications for LA therapy are quoted: homozygous familial hypercholesterolemia (HCH), severe HCH, and isolated elevation of Lp(a) and progress of atherosclerotic disease. A major focus is on the evidence of the effect of LA on cardiovascular outcome data, and the most important publications are cited in this context. The best studies have been performed in patients with elevated Lp(a) in whom cardiovascular events were reduced by more than 80%. Major adverse effects and contraindications are listed. The impact of an LA therapy on patient quality of life and the requirements they have to fulfill are also highlighted. Finally, the future role of LA in treating high-risk patients with high LDL-C and/or high Lp(a) is discussed. It is probable that the significance of LA for treating patients with elevated LDL-C will decrease (with the exception of homozygous familial HCH) due to the application of PCSK9 inhibitors. The antisense oligonucleotide against apolipoprotein(a) could replace LA in patients with high Lp(a), provided positive outcome data are generated. Keywords: LDL cholesterol, lipoprotein(a), lipid-lowering therapy, lipoprotein apheresis, cardiovascular outcome
format article
author Julius U
author_facet Julius U
author_sort Julius U
title Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection
title_short Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection
title_full Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection
title_fullStr Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection
title_full_unstemmed Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection
title_sort lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection
publisher Dove Medical Press
publishDate 2016
url https://doaj.org/article/a01e4e57bb044ec1a5a1779e2a6f6a58
work_keys_str_mv AT juliusu lipoproteinapheresisinthemanagementofseverehypercholesterolemiaandofelevationoflipoproteinacurrentperspectivesandpatientselection
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