Key result
In patients with severe hyperlipidemia, lipid apheresis demonstrated a trend toward reducing the cardiac event rate from 0.23 to 0.10 events per person-year, though this did not reach statistical significance (P=0.064).
Why the study?
Does lipid apheresis improve lipid profiles and reduce cardiac events in patients with severe hyperlipidemia and familial hypercholesterolemia?
Observational (n=11)
No
Does lipid apheresis improve lipid profiles and reduce cardiac events in patients with severe hyperlipidemia and familial hypercholesterolemia?
Absolute Event Rate: 0.1% vs 0.23%
p-value: p=0.064
Lipid apheresis effectively reduces LDL-C and may decrease the recurrence of cardiac events in patients with familial hypercholesterolemia, though high rates of statin intolerance drive significant patient interest in alternative therapies.
Should not yet change practice for lipid apheresis in severe hyperlipidemia; leaves open potential benefit pending larger randomized trials.
Lipid apheresis is used to treat patients with severe hyperlipidemia by reducing low-density lipoprotein cholesterol (LDL-C). This study examines the effect of apheresis on the lipid panel and cardiac event rates before and after apheresis. An electronic health record screen of ambulatory patients identified 11 active patients undergoing lipid apheresis with 10/11 carrying a diagnosis of FH. Baseline demographics, pre- and postapheresis lipid levels, highest recorded LDL-C, cardiac events, current medications, and first apheresis treatment were recorded. Patients completed a questionnaire and self-reported risk factors and interest in alternative treatment. There were significant reductions in mean total cholesterol (-58.4%), LDL-C (-71.9%), triglycerides (-51%), high-density lipoprotein (HDL) cholesterol (-9.3%), and non-HDL (-68.2%) values. Thirty-four cardiac events were documented in 8 patients before apheresis, compared with 9 events in 5 patients after apheresis. Our survey showed a high prevalence of statin intolerance (64%), with the majority (90%) of participants indicating an interest in alternative treatment options. Our results have shown that lipid apheresis primary effect is a marked reduction in LDL-C cholesterol levels and may reduce the recurrence of cardiac events. Apheresis should be compared to the newer alternative treatment modalities in a randomized fashion due to patient interest in alternative options.
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Lui et al. (2014) conducted an observational in Familial Hypercholesterolemia (n=11). Lipid apheresis vs. Pre-apheresis time period was evaluated on Cardiac event rate (events per person-year) (p=0.064). In patients with severe hyperlipidemia, lipid apheresis demonstrated a trend toward reducing the cardiac event rate from 0.23 to 0.10 events per person-year, though this did not reach statistical significance (P=0.064).
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