LDL Pheresis

This chapter gives an account of the treatment procedure known as LDL pheresis. It involves the removal of apo-B-containing low density lipoprotein (LDL) and lipoprotein(a) [Lp(a)]. LDL pheresis is indicated in the treatment of familial hypercholesterolemia (FH), which is an autosomal dominant disorder associated with mutations of hepatocyte apolipoprotein-B (apo-B) receptors resulting in decreased LDL removal by the liver. FH homozygotes have cholesterol in the range of 700-1200 mg/dl and heterozygotes have 350-500 mg/dl, resulting in premature coronary heart diseases. FDA approved indications for LDL pheresis are patients with hypercholesterolemia who are unresponsive to dietary and pharmacologic management or unable to tolerate medications. A single procedure reduces LDL cholesterol levels by 50-60% and treatment intervals every 2-3 weeks maintain an approximate 50% reduction in cholesterol levels. LDL pheresis is performed indefinitely to maintain target lipoprotein levels. Long-term outcome studies have demonstrated a significant reduction in the number of cardiovascular events. The use of angiotensin converting enzyme (ACE) inhibitors is contraindicated in patients undergoing LDL apheresis. © 2009 Elsevier Inc. All rights reserved.

Duke Scholars

Author Beth H. Shaz Pathology