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.
Highlights
In a recent publication, the author described the history of research in atherosclerosis, of the introduction of lipid-lowering drugs, and of lipoprotein apheresis (LA) into medical practice [1]
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
Another indication which was officially recognized for an extracorporeal therapy appeared to be a severe HCH associated with elevated LDL-cholesterol (LDL-C) concentrations, associated with cardiovascular diseases, despite the application of effective lipid-lowering drugs
Summary
The author described the history of research in atherosclerosis, of the introduction of lipid-lowering drugs, and of lipoprotein apheresis (LA) into medical practice [1]. A plasma exchange was performed, which has been replaced in the following years by more specific methods. Another indication which was officially recognized for an extracorporeal therapy appeared to be a severe HCH associated with elevated LDL-cholesterol (LDL-C) concentrations, associated with cardiovascular diseases, despite the application of effective lipid-lowering drugs. An elevation of lipoprotein(a) (Lp(a)) played an increasing role among those patients starting LA. This is explained by the more and more generally accepted significance of this atherogenic risk factor, and the absence of any effective drug to reduce Lp(a) levels and cardiovascular endpoints. The extracorporeal treatment removes lipoproteins from the blood—that is why “lipoprotein apheresis” should be preferred
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