Role of Lipoprotein Apheresis in Cardiovascular Disease Risk Reduction

Blood Purif. 2019;47(4):301-316. doi: 10.1159/000497447. Epub 2019 Feb 21.

Abstract

Background and aim: Elevated low-density lipoprotein cholesterol and/or lipoprotein(a) are established risk factors for cardiovascular disease (CVD). Management of hypercholesterolemia consists of drug therapies, including statins and proprotein convertase subtilisin/kexin type 9 inhibitors. In patients with familial hypercholesterolemia (FH), lipoprotein apheresis (LA) is utilized to control lipid levels. However, LA is not currently a standard therapy for non-FH. This review summarizes the literature regarding LA therapy in CVD prevention.

Methods: PubMed/MEDLINE databases were searched using the keywords "LA" and "CVD". Citations were individually reviewed for relevance.

Results: The efficacy of LA was clearly demonstrated, largely based on evidence from observational studies. In patients who are unresponsive to traditional lipid-lowering medications, LA effectively reduced serum lipoprotein levels and adverse cardiovascular events.

Conclusion: It was concluded that LA is a safe and effective technique that could be considered in the management of hypercholesterolemia and future risk. Randomized control trials would further support a role for LA as a therapeutic option.

Keywords: Atherosclerosis; Cardiovascular disease; Lipoprotein apheresis; Lipoprotein(a); Low-density lipoprotein; Peripheral vascular disease.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Atherosclerosis / blood
  • Atherosclerosis / etiology
  • Atherosclerosis / prevention & control
  • Atherosclerosis / therapy
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control
  • Cardiovascular Diseases / therapy*
  • Cholesterol, LDL / blood
  • Humans
  • Hypercholesterolemia / blood
  • Hypercholesterolemia / complications
  • Hypercholesterolemia / therapy
  • Lipoprotein(a) / blood*
  • Plasmapheresis* / adverse effects
  • Plasmapheresis* / methods
  • Risk Factors
  • Standard of Care
  • Treatment Outcome

Substances

  • Cholesterol, LDL
  • Lipoprotein(a)