Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association.

Creator(s)

Eugenia Gianos
P Barton Duell
Peter P. Toth
Patrick M. Moriarty
Gilbert R. Thompson
Eliot A. Brinton
Lisa C. Hudgins
Mary Nametka
Kathleen H. Byrne
Geetha Raghuveer, Children's Mercy HospitalFollow
Prashant Nedungadi
Laurence S. Sperling
American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Council on Peripheral Vascular Disease

Document Type

Article

Publication Date

12-2024

Identifier

DOI: 10.1161/ATV.0000000000000177

Abstract

Despite the availability of multiple classes of lipoprotein-lowering medications, some high-risk patients have persistent hypercholesterolemia and may require nonpharmacologic therapy. Lipoprotein apheresis (LA) is a valuable but underused adjunctive therapeutic option for low-density lipoprotein cholesterol and lipoprotein(a) lowering, particularly in children and adults with familial hypercholesterolemia. In addition to lipid lowering, LA reduces serum levels of proinflammatory and prothrombotic factors, reduces blood viscosity, increases microvascular myocardial perfusion, and may provide beneficial effects on endothelial function. Multiple observational studies demonstrate strong evidence for improved cardiovascular outcomes with LA; however, use in the United States is limited to a fraction of its Food and Drug Administration-approved indications. In addition, there are limited data regarding LA benefit for refractory focal segmental glomerulosclerosis. In this scientific statement, we review the history of LA, mechanisms of action, cardiovascular and renal outcomes data, indications, and options for treatment.

Journal Title

Arteriosclerosis, thrombosis, and vascular biology

Volume

44

Issue

12

First Page

304

Last Page

321

MeSH Keywords

Humans; Blood Component Removal; United States; Treatment Outcome; Biomarkers; American Heart Association; Lipoprotein(a); Cardiovascular Diseases; Cholesterol, LDL; Hyperlipoproteinemia Type II

Keywords

AHA Scientific Statements; blood component removal; cardiovascular diseases; cholesterol, LDL; familial hypercholesterolemia; glomerulosclerosis, focal segmental familial; lipoprotein(a); secondary prevention

Recommended Citation

Gianos E, Duell PB, Toth PP, et al. Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2024;44(12):e304-e321. doi:10.1161/ATV.0000000000000177