Lipoprotein apheresis: present and future uses.

Abstract

For the past 40 years, apheresis, in particular, lipoprotein apheresis, has been the therapy of choice to lower LDL-C for familial hypercholesterolemia patients with uncontrolled dyslipidemia and cardiovascular disease. With the advent of recent and future lipid-modifying agents and their ability to lower LDL-C, the question arises on what will be the future of lipoprotein apheresis. Lipoprotein apheresis lowers not only plasma levels of apolipoprotein B lipoproteins but also markers of vascular inflammation and blood rheology. Other vascular diseases, not necessarily associated with familial hypercholesterolemia, such as nephrotic syndrome and peripheral arterial disease have profited from lipoprotein apheresis therapy. In 2013, the Food and Drug Administration approved lipoprotein apheresis therapy for patients with focal segmental glomerulosclerosis. Since 2010, the German healthcare ministry has approved lipoprotein apheresis therapy for patients with an elevated lipoprotein(a) and ongoing cardiovascular disease irrespective of LDL-C levels. Recent and future lipid-modifying therapies will most likely reduce the practice of lipoprotein apheresis therapy for familial hypercholesterolemia patients. Future implications for lipoprotein apheresis will involve vascular diseases that are at present lacking clinically effective therapy, whereas acute and chronic reductions of lipids, vascular inflammation, and/or rheology may improve the clinical outcome.