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Alothman L, Bélanger AM, Ruel I, Brunham LR, Hales L, Genest J, Akioyamen LE. Health-related quality of life in homozygous familial hypercholesterolemia: A systematic review and meta-analysis. J Clin Lipidol 2021; 16:52-65. [PMID: 35027327 DOI: 10.1016/j.jacl.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/04/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disease characterized by extreme elevations of low-density lipoprotein cholesterol (LDL-C) and extremely premature atherosclerotic cardiovascular disease. To date, impacts of HoFH and its treatment on the psychosocial wellbeing of patients have been poorly characterized. OBJECTIVES We performed a systematic review of the association between HoFH and health-related quality of life (HRQL). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus guidelines. We searched MEDLINE, Embase, The Cochrane Controlled Register of Trials (CENTRAL), Pubmed, Scopus, AfricaWide (via EBSCO), and six trial registries and grey-literature databases from inception to May 2021 for published English-language literature examining HRQL and its determinants in HoFH. Studies were eligible if they included patients with confirmed HoFH and evaluated HRQL using validated tools. We performed a narrative synthesis of qualitative findings from included studies and, where data permitted, random-effects meta-analysis reporting standardized mean differences (SMD) and 95% confidence intervals (CIs). RESULTS Our review identified seven eligible studies examining HRQL in HoFH participants. Pooling data from two included studies, we found that relative to the general population, HoFH patients demonstrated significantly poorer HRQL in multiple dimensions of the 36-item Short-Form Health Survey (SF-36) with lower scores in physical functioning (SMD -0.37; 95% CI: -0.60, -0.15), role limitations due to physical health (SMD -0.63; 95% CI: -1.24, -0.02), social functioning (SMD -0.61; 95% CI: -1.19, -0.03), bodily pain (SMD -0.24; 95% CI: -0.46, -0.01), and general health (SMD -1.55; 95% CI: -1.80, -1.31). No differences were observed in domains of energy and vitality, mental health and emotional well-being, or role limitations due to emotional problems. Patients suffered high treatment burdens related to lipoprotein apheresis that compromised educational attainment and employment. However, few patients received psychological support in navigating their treatment challenges. No studies evaluated the association of HoFH with incident anxiety, depression, or other psychopathology. CONCLUSIONS Limited data are available on quality of life for patients with HoFH. The available data suggest that these patients may suffer disease-related impairments in quality of life. Future work should aim to elucidate relationships between HoFH and mental health outcomes and develop interventions to improve quality of life in this population.
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Affiliation(s)
- Latifah Alothman
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Alexandre M Bélanger
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Isabelle Ruel
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Liam R Brunham
- Department of Medicine, University of British Columbia, Vancouver, V5Z 1M9, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, V6Z 1Y6, Canada
| | - Lindsay Hales
- McGill University Health Center Medical Libraries, Montreal QC, H3G 1A4, Canada
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Montreal QC H4A 3J1, Canada
| | - Leo E Akioyamen
- Department of Medicine, University of Toronto, Toronto ON, M5S 1A8, Canada.
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2
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Evaluation of health and quality of life in apheresis patients – data from the WAA register. Transfus Apher Sci 2019; 58:641-644. [DOI: 10.1016/j.transci.2019.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022]
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Kayikcioglu M, Kuman-Tunçel O, Pirildar S, Yílmaz M, Kaynar L, Aktan M, Durmuş RB, Gökçe C, Temizhan A, Özcebe OI, Akyol TK, Okutan H, Sağ S, Oz Gul O, Salcioglu Z, Yenercag M, Altunkeser BB, Kuku I, Yasar HY, Kurtoğlu E, Demir M, Demircioğlu S, Pekkolay Z, Ílhan O, Tokgozoglu L. Clinical management, psychosocial characteristics, and quality of life in patients with homozygous familial hypercholesterolemia undergoing LDL-apheresis in Turkey: Results of a nationwide survey (A-HIT1 registry). J Clin Lipidol 2019; 13:455-467. [DOI: 10.1016/j.jacl.2019.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 01/18/2023]
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Cesaro A, Gragnano F, Fimiani F, Moscarella E, Diana V, Pariggiano I, Concilio C, Natale F, Limongelli G, Bossone E, Calabrò P. Impact of PCSK9 inhibitors on the quality of life of patients at high cardiovascular risk. Eur J Prev Cardiol 2019; 27:556-558. [PMID: 30913901 DOI: 10.1177/2047487319839179] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Arturo Cesaro
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta, Italy.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Felice Gragnano
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta, Italy.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Fabio Fimiani
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Elisabetta Moscarella
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta, Italy.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Vincenzo Diana
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta, Italy.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Ivana Pariggiano
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta, Italy.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Claudia Concilio
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta, Italy.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Francesco Natale
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | - Paolo Calabrò
- Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta, Italy.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
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De Gucht V, Cromm K, Vogt A, Julius U, Hohenstein B, Spitthöver RM, Ramlow W, Schettler VJJ, Maes S. Treatment-related and health-related quality of life in lipoprotein apheresis patients. J Clin Lipidol 2018; 12:1225-1233. [PMID: 29921556 DOI: 10.1016/j.jacl.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/27/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is evidence for beneficial effects of lipoprotein apheresis (LA) in terms of reduction of cardiovascular events and interventions, but quality of life (QOL) in LA patients has only been explored in small samples. OBJECTIVE In this study, both LA- or treatment-related and health-related QOL (HRQOL) were assessed in 206 LA patients. METHODS Mental and physical HRQOL of the LA patients was assessed by means of the SF-12 as well as the EQ-5D. Physical complaints were assessed by the Patient Health Questionnaire-15 and LA- or treatment-related QOL by the Apheresis Quality of Life Form, developed for this study. RESULTS Comparison with general population norms showed that LA patients scored significantly lower on HRQOL and significantly higher on physical complaints. A higher perceived impact of the treatment proved to have a significant negative association with HRQOL and a positive one with physical complaints. CONCLUSION Previous studies reported higher levels of QOL in LA patients. This study showed that treatment-related QOL contributes to HRQOL and physical complaints in LA patients. While many patients do not experience LA as a real burden and report positive effects of the treatment, there is also an important group of patients for whom this is not the case. Although the impact on QOL of LA patients does most probably not outweigh the cardiovascular benefits of the treatment, it is important to screen treatment-related QOL in LA patients to optimize care in a personalized way. Future research is needed to compare QOL in LA with non-LA patients with similar medical conditions.
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Affiliation(s)
- V De Gucht
- Department of Health and Medical Psychology, Leiden University, Leiden, The Netherlands.
| | - K Cromm
- Fresenius Medical Care, Bad Homburg, Germany
| | - A Vogt
- Stoffwechselambulanz, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - U Julius
- Lipidology, Department of Internal Medicine III, University hospital at the Technische Universität Dresden, Dresden, Germany
| | - B Hohenstein
- Lipidology, Department of Internal Medicine III, University hospital at the Technische Universität Dresden, Dresden, Germany
| | | | - W Ramlow
- Apheresis Center Rostock (ACR), Rostock, Germany
| | | | - S Maes
- Department of Health and Medical Psychology, Leiden University, Leiden, The Netherlands
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Toward an international consensus—Integrating lipoprotein apheresis and new lipid-lowering drugs. J Clin Lipidol 2017; 11:858-871.e3. [DOI: 10.1016/j.jacl.2017.04.114] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/30/2017] [Accepted: 04/15/2017] [Indexed: 12/11/2022]
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Schettler VJJ, Ringel J, Jacob S, Julius U, Klingel R, Heigl F, Roeseler E, Grützmacher P. Current insights into the German lipoprotein apheresis standard: PCSK9-inhibitors, lipoprotein apheresis or both? ATHEROSCLEROSIS SUPP 2017; 30:44-49. [PMID: 29096860 DOI: 10.1016/j.atherosclerosissup.2017.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
According to current European guidelines, lipid lowering therapy for progressive cardiovascular disease including cardiovascular events has to be focused on a target level for LDL-C. In contrast for Lp(a) a threshold has to be defined with respect to the method of measurement. However, due to new lipid lowering drug developments like PCSK9-inhibitors (PCSK-9-I) a therapeutic algorithm for patients with severe hypercholesterolemia or isolated Lipoprotein(a)-hyperlipoproteinemia with progressive cardiovascular disease may be necessary to manage the use of PCSK9-I, lipoprotein apheresis (LA) or both. The therapeutic approach for patients with homozygous familial hypercholesterolemia is unambiguous: In addition to LA, in order to improve LDL-C reduction, PCSK9-I could be applied. In patients with heterozygous familial hypercholesterolemia, PCSK9-I is to be applied first. If in addition to a pronounced LDL-C elevation, cardiovascular complications exist or if imaging techniques documented atherosclerotic changes pre-disposing for a cardiovascular event while LDL-C reduction is insufficiently reduced (LDL-C > 100 mg/dl (2.6 mmol/l)), LA treatment should then be applied as last resort. In patients with elevated Lp(a) concentrations (Lp(a) > 60 mg/dl (>120 nmol/l)) and established cardiovascular disease, therapy should rely primarily on LA methods. If in addition to high Lp(a) levels insufficiently treated LDL-C concentrations (LDL-C > 100 mg/dl (2.6 mmol/l)) exist, in rare cases PCSK9-I can supplement the lipid lowering concept.
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Affiliation(s)
| | - J Ringel
- Center for Dialysis Potsdam, Potsdam, Germany
| | - S Jacob
- Medical Center for Prevention and Therapy, Villingen-Schwenningen, Germany
| | - U Julius
- Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - R Klingel
- Apheresis Research Institute, Cologne, Germany; 1st Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - F Heigl
- Medical Care Centre Kempten-Allgäu, Kempten, Germany
| | - E Roeseler
- Center for Nephrology, Hypertension and Metabolic Diseases, Hannover, Germany
| | - P Grützmacher
- Department of Medicine II for Nephrology, Hypertension and Vascular Risks, AGAPLESION Markus Hospital, Frankfurt, Germany
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Julius U. Lipoprotein apheresis in the management of severe hypercholesterolemia and of elevation of lipoprotein(a): current perspectives and patient selection. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:349-360. [PMID: 27785114 PMCID: PMC5067066 DOI: 10.2147/mder.s98889] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This review reports the current situation with respect to therapeutic options (lifestyle and drugs) reducing the concentrations of atherogenic low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp[a]). Three lipoprotein apheresis (LA) principles have been realized: precipitation, filtration, and adsorption. Available LA methods are herein described in detail - major components, pumps, extracorporeal volume, treated volume, and anticoagulation. General features of all LA methods as well as pleotropic effects are elaborated. Indications for LA therapy are quoted: homozygous familial hypercholesterolemia (HCH), severe HCH, and isolated elevation of Lp(a) and progress of atherosclerotic disease. A major focus is on the evidence of the effect of LA on cardiovascular outcome data, and the most important publications are cited in this context. The best studies have been performed in patients with elevated Lp(a) in whom cardiovascular events were reduced by more than 80%. Major adverse effects and contraindications are listed. The impact of an LA therapy on patient quality of life and the requirements they have to fulfill are also highlighted. Finally, the future role of LA in treating high-risk patients with high LDL-C and/or high Lp(a) is discussed. It is probable that the significance of LA for treating patients with elevated LDL-C will decrease (with the exception of homozygous familial HCH) due to the application of PCSK9 inhibitors. The antisense oligonucleotide against apolipoprotein(a) could replace LA in patients with high Lp(a), provided positive outcome data are generated.
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Affiliation(s)
- Ulrich Julius
- Lipidology and Center for Extracorporeal Therapy, Department for Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
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Schettler VJJ, Ringel J, Jacob S, Julius U, Klingel R, Heigl F, Roeseler E, Grützmacher P. Therapiealgorithmus zur Lipoproteinapherese und PCSK9-Inhibition bei schwerer Hypercholesterinämie oder isolierter Lipoprotein(a)-Hyperlipoproteinämie. Internist (Berl) 2016; 57:511-6. [DOI: 10.1007/s00108-016-0043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Moriarty PM, Parhofer KG, Babirak SP, deGoma E, Duell PB, Hohenstein B, Ramlow W, Simha V, Steinhagen-Thiessen E, Thompson PD, Vogt A, von Stritzky B, Du Y, Manvelian G. Alirocumab in patients with heterozygous familial hypercholesterolemia undergoing lipoprotein apheresis: Rationale and design of the ODYSSEY ESCAPE trial. J Clin Lipidol 2016; 10:627-34. [DOI: 10.1016/j.jacl.2016.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 02/01/2016] [Indexed: 01/24/2023]
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