Therapeutic Apheresis in Dyslipidemia

In the last decades, LDL apheresis was introduced as an extracorporeal treatment option for patients with homozygous or severe heterozygous familial hypercholesterolemia. The prognosis of patients suffering from severe dyslipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein apheresis is the therapeutic option. There are six different LDL apheresis systems available today: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, direct adsorption of lipoproteins, and Liposorber D. There is a strong correlation between dyslipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe dyslipidemia therapeutic strategies focus on a drastic reduction of serum lipoproteins. Despite maximum therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. In such patients LDL apheresis is indicated. Technical and clinical aspects of these six different LDL apheresis methods are shown here. There were no significant differences with respect to all cholesterols, or triglyceride observed. The different published data clearly demonstrate that treatment with LDL apheresis in patients suffering from severe dyslipidemia refractory to conservative therapy is effective and safe in long application. A disadvantage is the high costs and the expensive technologies of the difChapter 1