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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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Víšek J, Bláha M, Bláha V, Lášticová M, Lánska M, Andrýs C, Tebbens JD, Igreja E Sá IC, Tripská K, Vicen M, Najmanová I, Nachtigal P. Monitoring of up to 15 years effects of lipoprotein apheresis on lipids, biomarkers of inflammation, and soluble endoglin in familial hypercholesterolemia patients. Orphanet J Rare Dis 2021; 16:110. [PMID: 33640001 PMCID: PMC7913462 DOI: 10.1186/s13023-021-01749-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
Background Lipoprotein apheresis (LA) is considered as an add-on therapy for patients with familial hypercholesterolemia (FH). We aimed to analyze the data collected in the last 15 years from FH patients treated with LA, to elucidate the benefit of this procedure with respect to plasma lipids, biomarkers of inflammation, and endothelial dysfunction and soluble endoglin. Results 14 patients (10 heterozygous FH patients (HeFH), 4 homozygous FH patients (HoFH)) were treated by long-term lipoprotein apheresis. Lipid levels were examined, and ELISA detected biomarkers of inflammation and soluble endoglin. Paired tests were used for intergroup comparisons, and a linear regression model served to estimate the influence of the number of days patients were treated with LA on the studied parameters. LA treatment was associated with a significant decrease of total cholesterol (TC), LDL-C, HDL-C, and apoB, in both HeFH and HoFH patients, after single apheresis and in a long-term period during the monitored interval of 15 years. Biomarkers of inflammation and endothelial dysfunction were reduced for soluble endoglin, hsCRP, and MCP-1, and sP-selectin after each procedure in some HeFH and HoFH patients. Conclusions LA treatment up to 15 years, reduced cholesterol levels, levels of biomarkers related to endothelial dysfunction, and inflammation not only after each procedure but also in the long-term evaluation in FH patients. We propose that long-term LA treatment improves lipid profile and endothelial dysfunction in familial hypercholesterolemia patients, suggesting a promising improvement in cardiovascular prognosis in most FH patients.
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Affiliation(s)
- J Víšek
- Metabolism and Gerontology, 3rd Department of Internal Medicine, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - M Bláha
- 4th Department of Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - V Bláha
- Metabolism and Gerontology, 3rd Department of Internal Medicine, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - M Lášticová
- Metabolism and Gerontology, 3rd Department of Internal Medicine, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - M Lánska
- 4th Department of Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - C Andrýs
- Department of Immunology and Allergology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - J Duintjer Tebbens
- Department of Biophysics and Physical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Ivone Cristina Igreja E Sá
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - K Tripská
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - M Vicen
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - I Najmanová
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - P Nachtigal
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic.
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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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Bláha V, Bláha M, Lánská M, Solichová D, Kujovská Krčmová L, Havel E, Vyroubal P, Zadák Z, Žák P, Sobotka L. Lipoprotein apheresis in the treatment of dyslipidaemia - the Czech Republic experience. Physiol Res 2017; 66:S91-S100. [PMID: 28379034 DOI: 10.33549/physiolres.933584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 1984, we started using therapeutic plasmapheresis (plasma exchange) as a method of extracorporeal lipoprotein elimination for the treatment of hypercholesterolemic patients. We evaluated the results of long-term therapy in 14 patients, 8 men and 6 women. The average age was 55.6+/-13.2 (range 28-70), median 59.5 years. 14 patients were diagnosed with familial hypercholesterolemia (FH): 5 homozygous, 9 heterozygous. Ten patients in the group were treated using immunoadsorption lipoprotein apheresis and 4 using hemorheopheresis. Immunoapheretic interventions decreased LDL-cholesterol (82+/-1 %), ApoB (73+/-13 %) and even Lp(a) by 82+/-19 %, respectively. Selected non-invasive methods are important for long-term and repeated follow-up. Carotid intima-media thickness showed improvement or stagnation in 75 % of the patients. Biomarkers of endothelial dysfunction such as endoglin (in the control group: 3.85+/-1.25 microg/l, in lipoprotein apheresis-treated hypercholesterolemic individuals 5.74+/-1.47 microg/l), CD40 ligand (before lipoprotein apheresis: 6498+/-2529 ng/l, after lipoprotein apheresis: 4057+/-2560 ng/l) and neopterin (before lipoprotein apheresis: 5.7+/-1.1 nmol/l, after lipoprotein apheresis: 5.5+/-1.3 nmol/l) related to the course of atherosclerosis, but did not reflect the actual activity of the disease nor facilitate the prediction or planning of therapy. Hemorheopheresis may improve blood flow in microcirculation in familial hypercholesterolemia and also in some other microcirculation disorders via significantly decreased activity of thrombomodulin (p<0.0001), tissue factor (p<0.0001), aggregation of thrombocytes (p<0.0001) and plasma and whole blood viscosity (p<0.0001). In conclusion, lipoprotein apheresis and hemorheopheresis substantially lowered LDL-cholesterol in severe hypercholesterolemia. Our experience with long-term therapy also shows good tolerance and a small number of complications (6.26 % non-serious clinical complications).
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Affiliation(s)
- V Bláha
- Third Department of Internal Medicine, Metabolism and Gerontology, University Hospital Hradec Králové and Charles University Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic.
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Wang A, Richhariya A, Gandra SR, Calimlim B, Kim L, Quek RGW, Nordyke RJ, Toth PP. Systematic Review of Low-Density Lipoprotein Cholesterol Apheresis for the Treatment of Familial Hypercholesterolemia. J Am Heart Assoc 2016; 5:e003294. [PMID: 27385428 PMCID: PMC5015370 DOI: 10.1161/jaha.116.003294] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/07/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Apheresis is an important treatment for reducing low-density lipoprotein cholesterol (LDL-C) in patients with familial hypercholesterolemia (FH). We systematically reviewed the current literature surrounding LDL-C apheresis for FH. METHODS AND RESULTS Electronic databases were searched for publications of LDL-C apheresis in patients with FH. Inclusion criteria include articles in English published in 2000-2013 that provide descriptions of practice patterns, efficacy/effectiveness, and costs related to LDL-C apheresis in patients with FH. Data were stratified by country and FH genotype where possible. Thirty-eight studies met the inclusion criteria: 8 open-label clinical trials, 11 observational studies, 17 reviews/guidelines, and 2 health technology assessments. The prevalence of FH was not well characterized by country, and underdiagnosis was a barrier to FH treatment. Treatment guidelines varied by country, with some guidelines recommending LDL-C apheresis as first-line treatment in patients with homozygous FH and after drug therapy failure in patients with heterozygous FH. Additionally, guidelines typically recommended weekly or biweekly LDL-C apheresis treatments conducted at apheresis centers that may last 2 to >3 hours per session. Studies reported a range for mean LDL-C reduction after apheresis: 57-75% for patients with homozygous FH and 58-63% for patients with heterozygous FH. Calculated annual costs (in US$2015) may reach US$66 374 to US$228 956 per patient for weekly treatment. CONCLUSIONS LDL-C apheresis treatment may be necessary for patients with FH when drug therapy is inadequate in reducing LDL-C to target levels. While apheresis reduces LDL-C, high per-session costs and the frequency of guideline-recommended treatment result in substantial annual costs, which are barriers to the optimal treatment of FH.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter P Toth
- University of Illinois College of Medicine, Peoria, IL Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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Blaha M, Andrys C, Langrova H, Studnicka J, Drsata J, Lanska M, Blaha V, Zak P. Changes of the complement system and rheological indicators after therapy with rheohemapheresis. ATHEROSCLEROSIS SUPP 2016; 18:140-5. [PMID: 25936318 DOI: 10.1016/j.atherosclerosissup.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In the last 10 years, many studies have been published on the role of the complement system in microcirculation disorders. However, as for the changes of complement components after rheohemapheresis, there is still a lack of detailed data in the literature. Complement changes may play an important role in pathogenesis of some microcirculation disorders, such as age-related macular degeneration and acute hearing loss. The objective of this study was to investigate the effect of rheohemapheresis on the basic complement pathways. PATIENTS AND METHODS 32 patients were treated with rheohemapheresis, including 16 patients (10 men and 6 women) for age-related macular degeneration (AMD), mean age 69.7 ± 6.06 years (range 62-87 years) and 16 patients (11 men and 5 women) aged 56.4 ± 11.5 (range 34-73 years) for acute hearing loss. RESULTS Rheohemapheresis led to a significant drop of all three complement-activation pathways in both groups of patients. Moreover, complement factor H was also reduced. CONCLUSION The observed reduction in all three basic complement activation pathways after rheohemapheresis could be clinically important. The search continues both to find substances which influence complement systems and to develop more effective new drugs that require less frequent administration and that provide improved intraocular therapy for AMD patients.
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Affiliation(s)
- M Blaha
- 4th Department of Internal Medicine - Hematology, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic.
| | - C Andrys
- Institute of Immunology and Allergology, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - H Langrova
- Department of Ophthalmology, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - J Studnicka
- Department of Ophthalmology, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - J Drsata
- Department of Otorhinolaryngology, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - M Lanska
- 4th Department of Internal Medicine - Hematology, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - V Blaha
- 3rd Department of Medicine - Metabolic Care and Gerontology, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - P Zak
- 4th Department of Internal Medicine - Hematology, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
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Blaha M, Pitha J, Blaha V, Lanska M, Maly J, Filip S, Brndiar M, Langrova H. Experience with extracorporeal elimination therapy in myasthenia gravis. Transfus Apher Sci 2011; 45:251-6. [DOI: 10.1016/j.transci.2011.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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