Diabetes and Lipid Clinic of Alaska

 

 


LDL Apheresis

Genetics aren’t always fair. Even when they eat right, exercise conscientiously and take medication, some people’s bodies simply manufacture too much cholesterol, placing them at high risk for heart disease.

However, people who have these extremely high cholesterol levels may be able to benefit from a life-saving treatment known as apheresis, which actually removes cholesterol directly from the blood. Diabetes and Lipid Clinic of Alaska one of only a few private practices in the nation and the only center in the state of Alaska (http://www.liposorber.com/home1.htm) offers on-site lipid apheresis treatment for people with extremely high cholesterol levels who do not respond to or cannot tolerate cholesterol-lowering drugs. We utilize the Liposorber LDL Apheresis System, a cutting-edge treatment that removes LDL (“bad”) cholesterol from the blood. Presently, the treatment is a life-long therapy that must be repeated about every two weeks and that is likely to remain necessary until additional types of cholesterol-lowering medicines become available.

The treatment is vital for the small number of patients who do not benefit enough from aggressive cholesterol-lowering drugs and lifestyle changes. These patients usually have too-high cholesterol levels (a condition known as hypercholesterolemia) due to their inherited family genetics and metabolism. With this new system, we can reduce the plaque build-up and inflammation in the arteries by rapidly lowering LDL levels. In many instances, we can then bring about plaque regression and a significant lowering of the patient’s risk for heart disease and stroke.

LDL apheresis is a procedure used to remove low-density lipoprotein (LDL), or "bad," cholesterol from the blood. LDL apheresis can be effective for people who:

  • Patients with an LDL-C levels of >200 mg/dL who have a documented history of coronary heart disease (CHD)
  • Patients with an LDL-C levels of >300 mg/dL without CHD
  • Any patient with LDL-C levels of >500 mg/dL

LDL apheresis removes LDL cholesterol and related harmful cholesterol particles from the blood through a special filtering machine. During a treatment session — which may take three to four hours to complete — blood is removed from the body through a needle (usually placed in a vein in the arm) and sent to the filtering machine in a plastic tube. The machine removes the LDL cholesterol from the blood and then returns the "clean" blood through another vein.

LDL apheresis significantly lowers LDL cholesterol after just one treatment, but it's not a permanent solution. Because LDL apheresis doesn't correct the cause of the high cholesterol, LDL levels are likely to increase again after treatment. Typically, LDL apheresis must be repeated every one to two weeks. It's also essential to continue taking cholesterol- lowering medications and to follow a healthy, low-fat diet.

Familial hypercholesterolemia

Familial hypercholesterolemia (FH) is a condition in which individuals have a genetic predisposition to very high cholesterol levels. Traditional lipid-lowering treatments help patients with FH but may not help these patients achieve their LDL-C goal. This is where treatment with LDL-apheresis becomes a feasible, and effective, option.
To appreciate how important LDL-apheresis therapy to these patients, consider this: Left untreated, or treated inadequately, patients with FH are at extremely high risk for premature heart disease, heart attack, and even death.

The Procedure

The LDL-apheresis process, performed by the Liposorber System, uses a state-of-the-art computer to control and monitor the removal of LDL cholesterol from the blood. To begin the three-hour procedure, patients are given the drug heparin to protect against blood clotting. Then, their blood is withdrawn from a vein in the arm and sent through a tube to the Liposorber System machine, where the plasma is separated from the red blood cells. The plasma flows through specialized adsorption columns within the system that use chemically coated cellulose beads to attract the LDL particles, removing them from the blood.

After the LDL is eliminated (and discarded as waste), the plasma is recombined with the red blood cells and pumped back into the patient’s body. The automated system has multiple safety features, and side effects are very rare. Further, the technicians operating the system remain with the patient during the treatment.

A single treatment can lower a patient’s LDL cholesterol by 73 to 83 percent, depending on how much plasma is processed through the Liposorber System during treatment. The number of LDL particles builds up again after treatment, so the process must be repeated at about two-week intervals in order to keep the LDL-cholesterol levels under control.

Candidates for the LDL-apheresis procedure must have very high LDL levels that have not responded adequately to diet and aggressive drug therapy. All patients are evaluated on a case-by-case basis to determine whether or not they qualify LDL-apheresis is generally administered every 2 weeks and lasts approximately 2 to 4 hours per treatment session. During the procedure, two intravenous (IV) lines are inserted into the patient’s arms (one IV per arm). Blood is drawn from the body through one IV and filtered through a specialized machine that traps and removes the LDL-C and other plaque causing particles. The patient’s blood is then returned to the body through the other IV.

LDL apheresis is a safe procedure with a low risk of side effects. Though uncommon, possible complications may include:

  • Increased bleeding in the days following the procedure
  • Infection
  • Too much or too little fluid in the bloodstream
  • Air in the bloodstream (air embolism)
  • Low blood pressure during the procedure and for a few hours afterward

The Results

Clinical trials have demonstrated that a single LDL-apheresis treatment removes approximately 60% to 70% of harmful LDL-C from the blood. Long-term effects include suppression of plaque formation and progression. It has also been demonstrates to cause regression of plaque. After more than 20 years of use, LDL-apheresis therapy has proven to be a safe and effective technique for treating excess LDL-C.

Where Is This Treatment Available?

LDL-apheresis is performed in more than 35 centers throughout the United States. However, in other parts of the world, including Germany and Japan, the treatment is better known and utilized more frequently. A perceived lack of awareness among both physicians and the general public about the benefits and availability—and likely even the existence— of LDL-apheresis may explain its limited use in the United States. The Diabetes and Lipid Clinic is the first and only clinic in the state of Alaska who offers this technology.

The information on this Web page is provided for educational purposes. You understand and agree that this information is not intended to be, and should not be used as, a substitute for medical treatment by a health care professional. You agree that Diabetes and Lipid Clinic of Alaska is not making a diagnosis of your condition or a recommendation about the course of treatment for your particular circumstances through the use of this Web page. You agree to be solely responsible for your use of information contained on this Web page

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