Abstract
The extracorporeal elimination of LDL-cholesterol could be performed using the classic non-selective centrifuge or membrane plasmapheresis. The modern methods are more selective and effective. The atherogenic particules are removed from plasma by active colon or capsula. The methods include: cascade filtration, imunoadsorbtion, heparin-induced precipitation of LDL, thermofiltration, dextran-induced precipitation of LDL and direct adsorption of lipids (DALI). The regular LDL-apheresis is the life-saving technique in the treatment of homozygous familial hypercholesterolaemia. It is used in heterozygous familial hypercholesterolaemia when the patients do not respond to diet and drugs therapy, too. The regular LDL-apheresis treatment may be followed by the decreased frequency of angina pain episodes, the reduction of ECG changes during the bicycle ergometry and significant disappearance of tendinous xantomas. Some prospective randomised studies has shown even in this group of patients, resistant to conventional treatment, a significant regression of atherosclerotic changes.
Highlights
Familial hypercholesterolemia and familial combined hyperlipidemia are genetic disorders which are, in their genotype, typical with high incidence of severe cardiovascular complications in young people
Importance of LDL-apheresis in familial hypercholesterolaemia could be summarised as follows: a) Technique is of unambiguous importance in treatment of homozygous patients – it is practically a case of lifesaving method
After Bruckert [11] there are three major reasons to treat homozygous patients: 1) their cardiovascular prognosis is very bad 2) drugs are ineffective and surgical procedures such as partial ileal bypass, portocaval shunt and liver transplantation have been associated with considerable morbidity, and 3) LDL apheresis decreases LDL-cholesterol and has been shown to be associated with improved life expectancy [4]. b) It is more difficult to form an opinion on the treatment efficacy in heterozygous patients, as these patients are generally recruited in a more advanced stage of their disease, are older and demonstrate a longer natural survival than homozygous patients
Summary
Familial hypercholesterolemia and familial combined hyperlipidemia are genetic disorders which are, in their genotype, typical with high incidence of severe cardiovascular complications in young people. Importance of LDL-apheresis in familial hypercholesterolaemia could be summarised as follows: a) Technique is of unambiguous importance in treatment of homozygous patients – it is practically a case of lifesaving method. The patients die at an age of 23–25 years due to the complications of premature atherosclerosis These homozygous patients, representing the highest risk group, allow already to conclude, that regression, primary prevention and secondary prevention can be achieved influencing both the quality of life and prolongation of survival [25]. The prevailing majority of these patients can be treated with a diet and hypolipidemic drugs only, 5–10 % of these patients have to be treated with LDL-apheresis It can be concluded in accordance with other authors, that LDL-apheresis seems to be a very useful method in these cases [25]
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