The patient, a 19-year-old from Ellicott City, Md., had levels of LDL (low density lipoprotein) – the so-called “bad” cholesterol – so high that he had to undergo coronary artery bypass at 15 years of age. Following the surgery, doctors used medications to lower his LDL cholesterol from 600-700 mg/dL to 300 mg/dL, but that was as low as they could go. With no apparent treatment in sight, that meant the teen was still at risk of significant atherosclerosis, coronary artery disease, heart attack and stroke at a young age. But then he and his family learned of a novel, alternative cholesterol-lowering treatment called LDL apheresis being offered to patients like him at the Johns Hopkins Lipid Clinic. He underwent the procedure and amazingly his LDL cholesterol had fallen to 73 mg/dL.
“The procedure went great, and I’m so glad it could be done,” says the boy’s mother. “Without the treatment he could have died from his condition.”
The condition she referred to is familial hypercholesterolemia, a genetic defect passed down through families that makes the body unable to remove LDL cholesterol from the bloodstream. Most patients with high cholesterol levels can be treated with a combination of diet, exercise and drugs, Johns Hopkins Lipid Clinic Director Peter Kwiterovich explains, but some patients, particularly those with more extreme familial hypercholesterolemia, do not respond as well to drug therapies. For them, LDL apheresis may be the sole answer.
“In these patients, LDL apheresis does what the body cannot do, dramatically reducing their LDL levels and their risk of heart attack and stroke,” Kwiterovich says.
Similar to kidney dialysis, in LDL apheresis blood is continually removed from a patient’s vein in the arm and run through a machine that separates the plasma from the red blood cells. The LDL and other “bad” lipoproteins are filtered out of the plasma while high-density lipoprotein (HDL), or “good” cholesterol, albumin and other beneficial plasma proteins are allowed to pass. The LDL depleted plasma is then recombined with the blood cells and returned to the patient via a different vein.
“So it removes all of the atherogenic molecules but not your good HDL,” Kwiterovich explains. “Patients get all their good plasma proteins back.”
Patients sit in a comfortable chair during the 2-4 hour procedure, but they may experience side effects like fatigue, nausea and in some cases chest pain. Kwiterovich adds that LDL apheresis must be administered every two weeks to keep LDL levels down.
“If they stop the LDL apheresis, their LDL values would go back up and they would stay there regardless of medication, and their atherosclerotic process would proceed,” Kwiterovich says. “It’s not a cure, but certainly there’s decreased progression of the atherosclerosis.”
The criteria for LDL apheresis includes coronary artery disease and LDL cholesterol above 200 mg/dL – or no coronary artery disease but LDL above 300 mg/dL – after all efforts have been made to lower LDL cholesterol with medications. For more information, call 410-614-0972.