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Lipoprotein Apheresis: Current Recommendations for Treating Familial Hypercholesterolemia and Elevated Lipoprotein(a)

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Abstract

Purpose of Review

Familial hypercholesterolemia (FH) and hyperlipoproteinemia(a) are relatively common disorders, posing a significant health burden due to increased risk of atherosclerotic cardiovascular disease (ASCVD). Development of electronic health record–based strategies with a linkage to the genetic test results has increased awareness, detection, and control of heritable lipid disorders. This review attempts to critically examine available data to provide a summary of the current evidence for lipoprotein apheresis in FH and elevated lipoprotein(a) (Lp(a)).

Review Findings

Availability and indications for lipoprotein apheresis vary across the globe. On average, greater than 60% of atherogenic apoB-containing lipoproteins are immediately reduced following a single procedure, translating in substantial reduction of incident ASCVD events, and preventing accelerated vascular aging. Simultaneous lipid-lowering therapy targeting low-density lipoprotein (LDL) and Lp(a) enhances the efficacy of lipoprotein apheresis. Lipoprotein apheresis alters the proteomics of the lipoprotein particles, including reduction in the concentration of the oxidized-LDL and Lp(a) particles, and proinflammatory apoE bound to HDL particles and remnant lipoproteins. Other effects attributed to lipoprotein apheresis include improvement in blood rheology, endothelial function, microvascular flow, myocardial perfusion, reduction in circulating inflammatory markers. Development of lipoprotein apheresis registries provides data on benefits, challenges, and barriers to inform pertinent healthcare policies.

Summary

Lipoprotein apheresis is a safe and effective procedure for lowering cholesterol in patients with combined and isolated FH and elevated Lp(a). It reduces the burden of ASCVD and improves long-term prognosis. A team approach is required by the patient, medical staff, and healthcare provider to initiate and maintain a lipoprotein apheresis program.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, University of Kansas Hospital and Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA

    Maya S. Safarova

  2. Division of Endocrinology, Metabolism and Genetics, Atherosclerosis and Lipoprotein Apheresis Center, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, KS, Kansas City, 66160, USA

    Patrick M. Moriarty

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  1. Maya S. Safarova
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Correspondence to Maya S. Safarova.

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Patrick M. Moriarty is a consultant for Kaneka Company, Osaka Japan. Maya S. Safarova has no conflicts of interest.

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Safarova, M.S., Moriarty, P.M. Lipoprotein Apheresis: Current Recommendations for Treating Familial Hypercholesterolemia and Elevated Lipoprotein(a). Curr Atheroscler Rep 25, 391–404 (2023). https://doi.org/10.1007/s11883-023-01113-2

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