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Heinl RE, Tennant HM, Ricketts JC, Rice CR, Robinson CB, Sandesara PB, Moriarty PM, Sperling L. Lipoprotein-X disease in the setting of severe cholestatic hepatobiliary autoimmune disease. J Clin Lipidol 2016; 11:282-286. [PMID: 28391896 DOI: 10.1016/j.jacl.2016.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022]
Abstract
Severe cholestatic disease and hyperlipidemia are both commonly encountered by medical professionals. This article reviews the current pathophysiological model of lipoprotein-X syndrome related to 3 cases from 2 academic medical centers in the United States.
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Affiliation(s)
- Robert E Heinl
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Heather M Tennant
- Department of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Claire R Rice
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Cordelia B Robinson
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Pratik B Sandesara
- Department of Medicine, Emory University, Atlanta, GA, USA; Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Patrick M Moriarty
- Department of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Laurence Sperling
- Department of Medicine, Emory University, Atlanta, GA, USA; Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA.
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Stefanutti C, Morozzi C, Di Giacomo S, Sovrano B, Mesce D, Grossi A. Management of homozygous familial hypercholesterolemia in real-world clinical practice: A report of 7 Italian patients treated in Rome with lomitapide and lipoprotein apheresis. J Clin Lipidol 2016; 10:782-789. [DOI: 10.1016/j.jacl.2016.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/02/2016] [Accepted: 02/18/2016] [Indexed: 12/13/2022]
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Lambert CT, Sandesara P, Isiadinso I, Gongora MC, Eapen D, Bhatia N, Baer JT, Sperling L. Current Treatment of Familial Hypercholesterolaemia. Eur Cardiol 2014; 9:76-81. [PMID: 30310490 DOI: 10.15420/ecr.2014.9.2.76] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Familial hypercholesterolaemia is an autosomal-dominant disorder associated with mutations in the LDL receptor gene resulting in markedly elevated plasma low-density lipoprotein cholesterol levels. FH is significantly underrecognised with as many as 1 in 300 having the heterozygous form and 1 in 1 million having the homozygous form of the disease. Early diagnosis and treatment of FH is paramount to reduce the risk of premature atherosclerotic cardiovascular disease and death. The goal of treatment is to reduce LDL-C by 50 % from baseline levels with lifestyle modification, pharmacologic lipid-lowering therapy, LDL apheresis and in rare cases, liver transplantation. Pharmacologic treatment ranges from statin medications to newer agents such as lomitapide, mipomersin and PCSK9 inhibitors. Combination therapy is frequently required to achieve goal lipoprotein level reductions and prevent complications.
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Affiliation(s)
- Cameron T Lambert
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Pratik Sandesara
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Ijeoma Isiadinso
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, US
| | | | - Danny Eapen
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Neal Bhatia
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Jefferson T Baer
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Laurence Sperling
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, US
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von Dryander M, Fischer S, Passauer J, Müller G, Bornstein SR, Julius U. Differences in the atherogenic risk of patients treated by lipoprotein apheresis according to their lipid pattern. ATHEROSCLEROSIS SUPP 2013; 14:39-44. [PMID: 23357139 DOI: 10.1016/j.atherosclerosissup.2012.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In high-risk patients who are already on a maximal lipid-lowering therapy, a lipoprotein apheresis is an important therapeutic option in preventing further progress of vascular complications as it may decrease both LDL-cholesterol (LDL-C) and lipoprotein(a) (Lp(a)) levels. We looked at the occurrence of cardiovascular events before apheresis and during apheresis in three groups defined by their lipid patterns at the start of an apheresis treatment: Group 1 (LDL-C ≥ 3.4 mmol/l and Lp(a) ≤ 600 mg/l; n = 35), Group 2 (LDL-C ≤ 3.4 mmol/l and Lp(a) ≥ 600 mg/l n = 37) and Group 3 (LDL-C ≥ 3.4 mmol/l and Lp(a) ≥ 600 mg/l; n = 15). Group 2 shows a time period of about 10 years from the first event until the start of apheresis treatment (compared to 2-6 years in the other two groups). Before the start of apheresis treatment 2.1 events per patient had occurred in Group 1, 3.4 events per patient in Group 2 and 1.8 events per patient in Group 3. Under apheresis therapy just 0.9 events per patient occurred in Group 1, 0.5 in Group 2 and 0.5 in Group 3. When comparing the two years before the start of apheresis treatment with the first two years under apheresis we saw the following reduction rates of cardiovascular events: Group 1-54%; Group 2-83%; Group 3-83.5%. Our results show that the reduction of cardiovascular events due to lipoprotein apheresis is especially high in patients with elevated levels of Lp(a) compared to patients with elevated LDL-C only indicating that physicians should be more focused on the risk factor elevated Lp(a).
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Affiliation(s)
- M von Dryander
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307 Dresden, Germany.
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Jug B, Papazian J, Lee R, Budoff MJ. Association of lipoprotein subfractions and coronary artery calcium in patient at intermediate cardiovascular risk. Am J Cardiol 2013; 111:213-8. [PMID: 23141758 DOI: 10.1016/j.amjcard.2012.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 01/07/2023]
Abstract
More precise estimation of the atherogenic lipid parameters could improve identification of residual risk beyond what is possible using traditional lipid risk factors. The aim of the present study was to explore the association between advanced analysis of lipoprotein subfractions and the prevalence of coronary artery calcium. Consecutive participants at intermediate cardiovascular risk who were undergoing computed tomographic assessment of coronary calcium (calcium score) were included. Using a validated ultracentrifugation method (the vertical autoprofile II test), cholesterol in eluting lipoprotein subfractions [i.e., low- (LDL), very-low-, intermediate-, and high-density lipoprotein subclasses, lipoprotein (a), and predominant LDL distribution] was directly quantified. A total of 410 patients were included (29% women, mean age 57 years), of whom 297 (72.4%) had coronary artery calcium. LDL pattern B (predominance of small dense particles) emerged as an independent predictor of coronary calcium after adjustment for traditional risk factors (odds ratio 4.46, 95% confidence interval 1.19 to 16.7). However, after additional stratification for dyslipidemia, as defined by conventional lipid profiling, a statistically significant prediction was only retained for high-density lipoprotein subfraction 2 (odds ratio 3.45, 95% confidence interval 2.03 to 50.1) and "real" LDL (odds ratio 6.10, 95% confidence interval 1.26 to 23.41) in the normolipidemia group and for lipoprotein (a) (odds ratio 7.81, 95% confidence interval 1.41 to 43.5) in the dyslipidemic group. In conclusion, advanced assessment of the lipoprotein subfractions [i.e., LDL pattern B, high-density lipoprotein subfraction 2, "real" LDL, and lipoprotein (a)] using the vertical autoprofile II test provided additional information to that of conventional risk factors on the prevalence of coronary artery calcium in patients at intermediate cardiovascular risk.
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Affiliation(s)
- Borut Jug
- Division of Cardiology, Los Angeles Biomedical Research Institute at UCLA-Harbor Medical Center, Torrance, California, USA.
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Reimann M, Julius U, Bornstein S, Fischer S, Reichmann H, Rüdiger H, Ziemssen T. Regular lipoprotein apheresis maintains residual cardiovascular and microvascular function in patients with advanced atherosclerotic disease. ATHEROSCLEROSIS SUPP 2013; 14:135-41. [DOI: 10.1016/j.atherosclerosissup.2012.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25:83-177. [PMID: 20568098 DOI: 10.1002/jca.20240] [Citation(s) in RCA: 352] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The American Society for Apheresis (ASFA) Apheresis Applications Committee is charged with a review and categorization of indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (fourth edition), the subcommittee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Fifth ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by refining the category definitions and by adding a grade of recommendation based on widely accepted GRADE system. The concept of a fact sheet was introduced in the Fourth edition and is only slightly modified in this current edition. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. The article consists of 59 fact sheets devoted to each disease entity currently categorized by the ASFA as category I through III. Category IV indications are also listed.
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Affiliation(s)
- Zbigniew M Szczepiorkowski
- Transfusion Medicine Service, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Beyer-Westendorf J, Seitz W, Jabs N, Bramlage P, Kuhlisch E, Julius U, Bornstein S, Schellong S. Nitric oxide and endothelin after lipid apheresis – a pilot study. ATHEROSCLEROSIS SUPP 2009; 10:70-3. [DOI: 10.1016/s1567-5688(09)71815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Low-density lipoprotein apheresis as a treatment option for hyperlipidemia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2009; 11:279-88. [DOI: 10.1007/s11936-009-0029-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stefanutti C, Vivenzio A, Giacomo SD, Mazzarella B, Bosco G, Berni A. Aorta and coronary angiographic follow-up of children with severe hypercholesterolemia treated with low-density lipoprotein apheresis. Transfusion 2009; 49:1461-70. [DOI: 10.1111/j.1537-2995.2009.02135.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Davidson MH, Robinson JG. Safety of aggressive lipid management. J Am Coll Cardiol 2007; 49:1753-62. [PMID: 17466224 DOI: 10.1016/j.jacc.2007.01.067] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 01/16/2007] [Accepted: 01/22/2007] [Indexed: 01/13/2023]
Abstract
Data from recent clinical trials of high- versus moderate-dose statin therapy support the recommendation to achieve a low-density lipoprotein (LDL) <100 mg/dl in high-risk patients and reveal that many patients will require a high-dose statin to achieve this goal. Overall, low rates of serious musculoskeletal (<0.6%) and hepatic (<1.3%) toxicity have been observed with high-dose statin therapy. In the long-term trials, atorvastatin 80 mg had higher rates of persistent transaminase elevations but rates of myopathy and rhabdomyolysis similar to lower doses of statins. The rate of myopathy and rhabdomyolysis for simvastatin 80 mg, although still low, was about 4x higher than for atorvastatin 80 mg and lower doses of statin. A similar margin of safety would be expected in properly selected patients with characteristics similar to those who participated in the clinical trials. High-dose statin therapy or combination therapy will be required for the large majority of very high-risk patients to achieve the optional LDL goal of <70 mg/dl. While the combination of ezetimibe, bile-acid sequestering agents, niacin, and fenofibrate with moderate dose statins appears to be reasonably safe, the long-term safety of combination with high-dose statins remains to be established. In order to optimize patient outcomes, clinicians should be aware of specific patient characteristics, such as advancing age, gender, body mass index, or glomerular filtration rate, which predict muscle and hepatic statin toxicity.
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Affiliation(s)
- Michael H Davidson
- Radiant Research, Rush University Medical Center, Chicago, Illinois, USA.
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Szczepiorkowski ZM, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Shaz BH, Weinstein R, Wirk A, Winters JL. Guidelines on the use of therapeutic apheresis in clinical practice—Evidence-based approach from the apheresis applications committee of the American society for apheresis. J Clin Apher 2007; 22:106-75. [PMID: 17394188 DOI: 10.1002/jca.20129] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Society for Apheresis (ASFA) Apheresis Applications Committee is charged with a review and categorization of indications for therapeutic apheresis. This elaborate process had been undertaken every 7 years resulting in three prior publications in 1986, 1993, and 2000 of "The ASFA Special Issues." This article is the integral part of the Fourth ASFA Special Issue. The Fourth ASFA Special Issue is significantly modified in comparison to the previous editions. A new concept of a fact sheet has been introduced. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. A detailed description of the fact sheet is provided. The article consists of 53 fact sheets devoted to each disease entity currently categorized by the ASFA. Categories I, II, and III are defined as previously in the Third Special Issue. However, a few new therapeutic apheresis modalities, not yet approved in the United States or are currently in clinical trials, have been assigned category P (pending) by the ASFA Clinical Categories Subcommittee. The diseases assigned to category IV are discussed in a separate article in this issue.
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Affiliation(s)
- Zbigniew M Szczepiorkowski
- Transfusion Medicine Service, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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