Klaus G. Parhofer, Germany
Marchioninistr. 15 Internal Medicine IV, Metabolism and EndocrinologyPresenter of 1 Presentation
Over 30 years of elaborate experience in LDL apheresis: an effective and well-tolerated treatment option for specific patient subgroups
Abstract
Background and Aims
Low-density lipoprotein cholesterol (LDL-c) and lipoprotein(a) (Lp(a)) are independant cardiovascular risk factors. Although modern drugs allow to reach treatment targets in most patients, for a subgroup of patients (patients with homozygous familial hypercholesterolaemia, patients with persistent dislipidaemia due to either drug resistance or intolerance, and patients with severely elevated Lp(a)) regular lipoprotein apheresis is the only option to improve cardiovascular outcome.
Methods
Between 1987 and 2018 our apheresis center at the University of Munich has conducted a total of 44,236 lipoprotein apheresis sessions, corresponding to a mean of 1,340 sessions per year in a total of 140 patients.
Results
On average each apheresis treatment decreases LDL-c and Lp(a) levels by 60-67% in a representative sample. The procedure is generally well-tolerated, with hypotension due to volume depletion being the most common side effect. Out of 140 patients, 21 patients (15%) died, whereas 70 patients (50%) stopped treatment due to a variety of other reasons, i.e. change of place of residence (25.7%), introduction of more potent drugs (newer statins, PCSK9-inhibitors) and thus rendering apheresis redundant (12.9%), senescence (2.1%) and other causes (7.9%). Only 2 patients (1.4%) stopped apheresis because of intolerance. 56 patients are currently treated in our center, 4 of them have been treated for more than 30 years.
Conclusions
In our experience, treatment success is associated with a number of factors such as experience (high quantity of procedures) and the engagement of a consistent medical staff, resulting in an elaborate expert knowledge of both, applied techniques and individual patient characteristics.