Lipoprotein apheresis is a specialized medical treatment designed to remove specific harmful substances from the blood. This sophisticated procedure plays a role in managing conditions where conventional therapies are not sufficient. It offers a targeted approach to address elevated levels of certain lipoproteins that contribute to serious health concerns.
Understanding Lipoprotein Apheresis
Lipoprotein apheresis is a medical procedure that removes low-density lipoprotein (LDL) cholesterol and lipoprotein(a) [Lp(a)] from the blood. This extracorporeal process, meaning blood is treated outside the body, aims to reduce the risk of cardiovascular disease. It is prescribed for severe hyperlipidemia when conventional treatments like diet modifications and medications are ineffective or insufficient.
It is commonly used for patients with severe familial hypercholesterolemia (FH), an inherited genetic disorder causing extremely high cholesterol from birth, which significantly increases the risk of early cardiovascular disease. Additionally, it addresses elevated lipoprotein(a) levels, which are an independent risk factor for cardiovascular disease, arterial thrombosis, and calcific aortic stenosis. Lipoprotein apheresis can also reduce serum levels of proinflammatory and prothrombotic factors, decrease blood viscosity, and improve microvascular myocardial perfusion.
The Procedure Explained
The lipoprotein apheresis procedure involves drawing blood from the patient, similar to a blood donation. This blood then flows through a specialized machine, which separates the plasma from the blood cells. The plasma, containing the target lipoproteins like LDL and Lp(a), is then passed through an adsorber column.
These columns contain materials that selectively bind to and remove the harmful lipoproteins while largely preserving beneficial components like high-density lipoprotein (HDL) and albumin. Once the plasma is “cleaned” of these lipoproteins, it is recombined with the patient’s blood cells and returned to the body through a different vein. A typical session usually lasts between two to four hours and is often performed weekly or every two weeks, depending on the individual’s needs and response to treatment.
Who is a Candidate for Lipoprotein Apheresis?
Candidates for lipoprotein apheresis are individuals with severely elevated LDL cholesterol or Lp(a) levels that have not responded adequately to standard treatments, including lifestyle changes and maximal doses of lipid-lowering medications. For patients with homozygous familial hypercholesterolemia (HoFH), lipoprotein apheresis is considered a first-line therapy, with treatment potentially beginning as early as 3 years of age.
For those with heterozygous familial hypercholesterolemia (HeFH) and additional cardiovascular disease risk factors, apheresis may be considered if LDL cholesterol remains above 200 mg/dL, or above 160 mg/dL if cardiovascular disease or diabetes is present. Patients with progressive cardiovascular disease and Lp(a) concentrations exceeding 60 mg/dL may also be eligible. Patients are evaluated to ensure they meet specific diagnostic criteria and that conventional therapies have been fully utilized.
Expected Outcomes and Considerations
Lipoprotein apheresis is highly effective in acutely reducing LDL cholesterol levels, typically by 50% to 65% after a single treatment. Lp(a) concentrations can decrease by approximately 60% to 75% per session. While these reductions are significant, lipoprotein levels begin to rise again shortly after treatment, necessitating regular, ongoing sessions to maintain lower levels.
Common side effects associated with the procedure are generally mild and may include low blood pressure, nausea, light-headedness, or headache. To ensure sufficient blood flow, patients usually have two needles placed in their veins, often in the arms; in some cases, a more permanent access like an arteriovenous fistula may be considered. The long-term commitment to regular treatments means integrating apheresis into one’s life, which can impact daily schedules, but it has shown to reduce cardiovascular events and slow the progression of atherosclerosis.