Some patients – especially those with Familial Hypercholesterolemia (FH) – are unable to achieve adequate control of their LDL cholesterol even with the aggressive use of medications, diet, and exercise. In these individuals it is at times necessary to utilize LDL-Apheresis to adequately decrease their risk of a severe cardiovascular event such as a heart attack, stroke, or even sudden cardiac death.
LDL is often referred to as the “bad” cholesterol because high levels are clearly associated with heart attack and stroke. (HDL has been dubbed the “good” cholesterol because high levels are associated with a diminished risk of heart attack and stroke). Patients with FH have LDL-C levels that can exceed 500 mg/dl. These patients are among the highest risk individuals for severe cardiovascular disease. The optimal management of FH consists of pharmaceutical therapy combined with intensive lifestyle changes in order to try to achieve an LDL-C as low as possible. When these measures fail to get the LDL-C under 200 mg/dl, LDL-Apheresis is often indicated.
LDL-Apheresis has been used in Europe since 1986 and the United States since 1997. Currently there are approximately forty LDL-Apheresis Centers in the nation, but only a single B.Braun site in Florida. The Baum Center for Comprehensive Lipid Management, a sub-division of Preventive Cardiology Inc., recognized the unmet need for such a site and therefore added LDL-Apheresis to complete its lipid management armamentarium. As FH occurs in one out of every 500 Americans (with groups such as South African Ashkenazi Jews, Christian Lebanese, and French Canadians having a much higher incidence), there are likely over 20,000 patients with this disorder in South Florida alone. Sadly this often-fatal disease is commonly undiagnosed, leaving many people sub-optimally treated. Organizations such as the National Lipid Association, the American Society for Preventive Cardiology, and the FH Foundation are doing everything they can to raise awareness of this disorder among doctors and the lay public. Some companies, such as Genzyme, Aegerion, and Regeneron are also doing what they can to raise awareness and even bring novel medicines to market in order for physicians to more effectively
treat this disorder.
When LDL-Apheresis is needed, this is what a patient can anticipate. Every other week the patient will undergo LDL-Apheresis, a blood-cleansing process that takes about two hours with the B Braun machine. Two IV lines are used, one in each arm. During the two hours, small amounts of blood are continuously withdrawn from the body. The blood is separated into red blood cells and other constituents (plasma). The plasma is treated with a medication in order to remove LDL-C. The cleansed blood is returned to the body and the end result is typically an LDL-C drop of about 60%. This would mean that if your starting LDL-C is 200 mg/dl, at the end of the two hours, your LDL-C will be approximately 80 mg/dl. Because levels tend to rise after the procedure, it typically must be performed every other week. Some literature has suggested that this method of treating appropriate FH patients can decrease their cardiovascular disease risk by about 75%. The procedure is fast, painless (except for the minor discomfort of IV insertion), and very safe. It represents a very significant and effective modality in the Clinical Lipidologist’s (Cholesterol expert) tool chest. We are proud to be able to offer this therapy to appropriate patients.