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Pediatric Heart News - For familial hypercholesterolemia, LDL apheresis offers fast help

Pediatric Heart News Winter 2012

For familial hypercholesterolemia, LDL apheresis offers fast help

Date: March 1, 2012

Peter Kwiterovich
Peter Kwiterovich heads the Johns Hopkins Lipid Clinic.

What do you do when your LDL cholesterol level is so high that you’re a walking poster child for the risks of atherosclerosis—a heart attack or stroke waiting to happen—and the cholesterol-lowering medication powerful enough to control your disease hasn’t been invented yet?

Even worse, what if you’re still a teenager, and you’ve already had a coronary artery bypass?

There is hope, in the form of LDL apheresis. Not everybody needs it; only an estimated one out of 300,000 people has cholesterol that can’t be brought down low enough with medications, exercise, diet and other alternatives. But if you’re like “Ethan,” born with familial hypercholesterolemia—whose LDL cholesterol was spiraling out of control at nearly 700 mg/dL and only came down to around 300 mg/dL with medical therapy—then this might just save your life. It brought Ethan’s LDL down to a safe 73 mg/dL.

“For some patients,” says pediatrician and atherosclerosis expert Peter Kwiterovich, “particularly those with more extreme familial hypercholesterolemia, this may be the sole answer.”

In LDL apheresis, the low-density lipoproteins are filtered out of the plasma, while high-density lipoproteins, albumin and other helpful plasma proteins are allowed to stay. Through a catheter in the patient’s arm, blood is pumped through a machine that separates the plasma from the red blood cells. After the LDL is filtered out, the plasma is recombined with the blood cells and returned to the patient through a different vein.

“Patients get all their good plasma proteins back,” says Kwiterovich. “In these patients, LDL apheresis does what the body cannot do: dramatically reduce their LDL levels and their risk of heart attack and stroke.”

The procedure takes between two and four hours, and it is not a permanent fix; it must be repeated every two weeks to keep LDL levels down. Side effects can include fatigue, nausea and, occasionally, chest pain. “It’s not a cure,” stresses Kwiterovich, “but certainly there’s decreased progression of the atherosclerosis.”

Those eligible are patients with coronary artery disease and LDL cholesterol levels above 200 mg/dL, or no coronary artery disease and LDL levels above 300 mg/dL that have not responded to other forms of therapy. 

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