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Safety and Effectiveness of Long-Term LDL-Apheresis in Patients at High Risk
Current Opinion in Lipidology
1998;9:521-526.
Joachim Thiery, Dietrich Seidel
LDL-apheresis is especially useful in hypercholesterolemic patients who do not respond
to standard drug and diet therapies alone, in individuals suffering from homozygous
or heterozygous familial hypercholesterolemia, in individuals resistant to treatment,
and in individuals who cannot tolerate statin treatment. All LDL-apheresis methods
(immunoadsorption with anti-apoprotein B100, dextran sulfate, and heparin-induced)
have shown effectiveness in decreasing total cholesterol and LDL-C from 60% to 75%.
However, each system does have its own specificities. For example, in addition to
LDL-C, immunoadsorption can also reduce lipoprotein and albumin levels, whereas
the heparin-induced method is effective at removing fibrinogen, resulting in rheologic
changes. This article reviews the safety and clinical effectiveness of long-term
LDL-apheresis through a discussion of numerous clinical studies.
A number of clinical studies have shown:
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LDL-apheresis significantly and favorably influences the progression of coronary
artery disease.
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LDL-apheresis reduces the number of adverse clinical events and prolongs survival
time for patients with coronary heart disease.
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Studies using the dextran sulfate and heparin-induced methods exhibited dramatic
(albeit not statistically significant) reductions in the rate of cardiovascular
events. |
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LDL-apheresis via the heparin-induced method has demonstrated success in the treatment
of heart transplant recipients.
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LDL-apheresis reduces the incidence of graft vessel disease. |
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Given the potential for adverse effects when statins are used in conjunction with
immunosuppressive therapy, LDL-apheresis provides an effective alternative. |
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LDL-apheresis decreases the susceptibility of LDL to oxidation and improves endothelial-mediated
vasomotion.
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LDL-apheresis prolongs the lag time of copper-induced LDL oxidation. |
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Therapy with the heparin-induced method increases the levels of plasmalogen phospholipids,
which have been previously shown to enhance resistance to LDL oxidation; these effects
were most pronounced 48 posttreatment, with subsequent waning of the effect. |
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Studies also indicate that the fatty-acid composition of LDL-C can be altered by
LDL-apheresis with an increase in oleic acid and a decrease in arachidonic acid
following apheresis; these changes may decrease oxidative susceptibility. |
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LDL-apheresis positively influenced blood flow in studies examining forearm, coronary,
and myocardial systems. |
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The authors also mention the use of LDL-apheresis as a method to benefit patients
suffering from other ischemic manifestations and in cases of sudden hearing loss.
Click for full abstract.
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