scholarly journals Monitoring of up to 15 years effects of lipoprotein apheresis on lipids, biomarkers of inflammation, and soluble endoglin in familial hypercholesterolemia patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
J. Víšek ◽  
M. Bláha ◽  
V. Bláha ◽  
M. Lášticová ◽  
M. Lánska ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Familial Hypercholesterolemia ◽  
Plasma Lipids ◽  
Lipid Levels ◽  
Lipoprotein Apheresis ◽  
Cholesterol Levels ◽  
Cardiovascular Prognosis ◽  
Soluble Endoglin ◽  
Term Evaluation

Abstract Background Lipoprotein apheresis (LA) is considered as an add-on therapy for patients with familial hypercholesterolemia (FH). We aimed to analyze the data collected in the last 15 years from FH patients treated with LA, to elucidate the benefit of this procedure with respect to plasma lipids, biomarkers of inflammation, and endothelial dysfunction and soluble endoglin. Results 14 patients (10 heterozygous FH patients (HeFH), 4 homozygous FH patients (HoFH)) were treated by long-term lipoprotein apheresis. Lipid levels were examined, and ELISA detected biomarkers of inflammation and soluble endoglin. Paired tests were used for intergroup comparisons, and a linear regression model served to estimate the influence of the number of days patients were treated with LA on the studied parameters. LA treatment was associated with a significant decrease of total cholesterol (TC), LDL-C, HDL-C, and apoB, in both HeFH and HoFH patients, after single apheresis and in a long-term period during the monitored interval of 15 years. Biomarkers of inflammation and endothelial dysfunction were reduced for soluble endoglin, hsCRP, and MCP-1, and sP-selectin after each procedure in some HeFH and HoFH patients. Conclusions LA treatment up to 15 years, reduced cholesterol levels, levels of biomarkers related to endothelial dysfunction, and inflammation not only after each procedure but also in the long-term evaluation in FH patients. We propose that long-term LA treatment improves lipid profile and endothelial dysfunction in familial hypercholesterolemia patients, suggesting a promising improvement in cardiovascular prognosis in most FH patients.

scholarly journals Lipoprotein Apheresis in the Treatment of Dyslipidemia – the Czech Republic Experience

2017 ◽  
pp. S91-S100 ◽  
Author(s):  
V. BLÁHA ◽  
M. BLÁHA ◽  
M. LÁNSKÁ ◽  
D. SOLICHOVÁ ◽  
L. KUJOVSKÁ KRČMOVÁ ◽  
...  
Keyword(s):  
Familial Hypercholesterolemia ◽  
Ldl Cholesterol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Cd40 Ligand ◽  
Term Therapy ◽  
Control Group ◽  
Lipoprotein Apheresis ◽  
Long Term Therapy

In 1984, we started using therapeutic plasmapheresis (plasma exchange) as a method of extracorporeal lipoprotein elimination for the treatment of hypercholesterolemic patients. We evaluated the results of long-term therapy in 14 patients, 8 men and 6 women. The average age was 55.6±13.2 (range 28-70), median 59.5 years. 14 patients were diagnosed with familial hypercholesterolemia (FH): 5 homozygous, 9 heterozygous. Ten patients in the group were treated using immunoadsorption lipoprotein apheresis and 4 using hemorheopheresis. Immunoapheretic interventions decreased LDL-cholesterol (82±1 %), ApoB (73±13 %) and even Lp(a) by 82±19 %, respectively. Selected non-invasive methods are important for long-term and repeated follow-up. Carotid intima-media thickness showed improvement or stagnation in 75 % of the patients. Biomarkers of endothelial dysfunction such as endoglin (in the control group: 3.85±1.25 μg/l, in lipoprotein apheresis-treated hypercholesterolemic individuals 5.74±1.47 μg/l), CD40 ligand (before lipoprotein apheresis: 6498±2529 ng/l, after lipoprotein apheresis: 4057±2560 ng/l) and neopterin (before lipoprotein apheresis: 5.7±1.1 nmol/l, after lipoprotein apheresis: 5.5±1.3 nmol/l) related to the course of atherosclerosis, but did not reflect the actual activity of the disease nor facilitate the prediction or planning of therapy. Hemorheopheresis may improve blood flow in microcirculation in familial hypercholesterolemia and also in some other microcirculation disorders via significantly decreased activity of thrombomodulin (p<0.0001), tissue factor (p<0.0001), aggregation of thrombocytes (p<0.0001) and plasma and whole blood viscosity (p<0.0001). In conclusion, lipoprotein apheresis and hemorheopheresis substantially lowered LDL-cholesterol in severe hypercholesterolemia. Our experience with long-term therapy also shows good tolerance and a small number of complications (6.26 % non-serious clinical complications).

scholarly journals Study of lipid levels in diabetes mellitus with special reference to diabetic retinopathy

2018 ◽  
Vol 5 (4) ◽  
pp. 905
Author(s):  
Shyam Sundar C. M. ◽  
Vaneet Jearth
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Lipid Levels ◽  
Visual Disability ◽  
Cholesterol Levels ◽  
Lipid Fractions ◽  
The Mean ◽  
The Relationship ◽  
Control Study

Background: Diabetic retinopathy is a very common, potentially preventable, long term, microvascular complication of diabetes mellitus and leading cause of visual disability and blindness. It is considered hallmark of generalized microangiopathy occurring in diabetic patient. The present study was designed to study the lipid levels in patients of diabetes mellitus and further analyse the data with reference to occurrence of diabetic retinopathy.Methods: It was a case control study of 30 cases consisting patients with diabetic retinopathy and 30 controls with diabetes and no diabetic retinopathy. Fasting lipid profile, FBS, PPBS, HbA1C and BMI were measured in all subjects.Results: 34 males (57%) and 26 (43%) females were recruited in the study. The mean duration of diabetes was 8.5±5 yrs. The average HbA1C was 8.2±1.3 in Diabetic Retinopathy (DR) group and 7.5±0.9 in patients with no Diabetic Retinopathy (NDR). 21 (70%) patients in DR group had dyslipidaemia, whereas 13 (43.3%) patients in NDR had dyslipidaemia, average cholesterol was 188.30±46.48 mg/dl in patients with DR, 182.50±34.74 mg/dl in patients without DR.Conclusions: Dyslipidaemia was found to be more common in patients having Diabetic Retinopathy than in those without DR and the association was statistically significant. Mean cholesterol levels were found to be higher in cases and mean HDL level was found to be higher in controls but the relationship was not found to be statistically significant. No association was found between other lipid fractions and retinopathy.

scholarly journals Long-term efficacy of lipoprotein apheresis and lomitapide in the treatment of homozygous familial hypercholesterolemia (HoFH): a cross-national retrospective survey

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laura D’Erasmo ◽  
Antonio Gallo ◽  
Angelo Baldassare Cefalù ◽  
Alessia Di Costanzo ◽  
Samir Saheb ◽  
...  
Keyword(s):  
Familial Hypercholesterolemia ◽  
Treatment Algorithm ◽  
Lipid Lowering ◽  
Homozygous Familial Hypercholesterolemia ◽  
Lipoprotein Apheresis ◽  
Term Efficacy ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background Homozygous familial hypercholesterolemia (HoFH) is a rare life-threatening condition that represents a therapeutic challenge. The vast majority of HoFH patients fail to achieve LDL-C targets when treated with the standard protocol, which associates maximally tolerated dose of lipid-lowering medications with lipoprotein apheresis (LA). Lomitapide is an emerging therapy in HoFH, but its place in the treatment algorithm is disputed because a comparison of its long-term efficacy versus LA in reducing LDL-C burden is not available. We assessed changes in long-term LDL-C burden and goals achievement in two independent HoFH patients’ cohorts, one treated with lomitapide in Italy (n = 30) and the other with LA in France (n = 29). Results The two cohorts differed significantly for genotype (p = 0.004), baseline lipid profile (p < 0.001), age of treatment initiation (p < 0.001), occurrence of cardiovascular disease (p = 0.003) as well as follow-up duration (p < 0.001). The adjunct of lomitapide to conventional lipid-lowering therapies determined an additional 58.0% reduction of last visit LDL-C levels, compared to 37.1% when LA was added (padj = 0.004). Yearly on-treatment LDL-C < 70 mg/dl and < 55 mg/dl goals were only achieved in 45.5% and 13.5% of HoFH patients treated with lomitapide. The long-term exposure to LDL-C burden was found to be higher in LA than in Lomitapide cohort (13,236.1 ± 5492.1 vs. 11,656.6 ± 4730.9 mg/dL-year respectively, padj = 0.002). A trend towards fewer total cardiovascular events was observed in the Lomitapide than in the LA cohort. Conclusions In comparison with LA, lomitapide appears to provide a better control of LDL-C in HoFH. Further studies are needed to confirm this data and establish whether this translates into a reduction of cardiovascular risk.

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