Imperial College, Hammersmith Hospital, London, UK.
Curr Opin Lipidol. 2010 Dec;21(6):492-8. doi: 10.1097/MOL.0b013e3283402f53.
Despite the use of currently available lipid-lowering therapies, a significant proportion of patients with severe hypercholesterolaemia do not reach treatment goals and consequently remain at increased risk for cardiovascular disease (CVD). On the basis of clinical experience, these patients tend to have the most severe forms of familial hypercholesterolaemia or markedly elevated LDL cholesterol (LDL-C) levels but are unable to tolerate statin therapy.
LDL apheresis is currently the best treatment option (or treatment rescue) to bring these patients closer to therapeutic LDL objectives, and has been shown to reduce the risk of CVD along with LDL-C levels. However, criteria for LDL apheresis eligibility and the percentage of patients receiving treatment vary widely from country to country across Europe. Despite the proven benefits of LDL apheresis, access to this procedure remains limited because of its high cost and low availability, reflecting inherent limitations of this treatment modality.
There is a need to both better define the patient population eligible for LDL apheresis and to create unified European guidelines governing the use of apheresis. In addition to improving access to apheresis where appropriate, new therapies are needed to further decrease LDL-C and reduce the ongoing CVD risk in patients with severe hypercholesterolaemia.
尽管目前使用了降脂疗法，仍有相当一部分严重高胆固醇血症患者未达到治疗目标，因此仍面临心血管疾病（CVD）风险增加的问题。基于临床经验，这些患者往往患有最严重的家族性高胆固醇血症或明显升高的 LDL 胆固醇（LDL-C）水平，但不能耐受他汀类药物治疗。
LDL 吸附目前是使这些患者更接近治疗性 LDL 目标的最佳治疗选择（或治疗挽救），并已被证明可降低 CVD 风险和 LDL-C 水平。然而，在整个欧洲，LDL 吸附的适应证标准和接受治疗的患者比例因国家而异，差异很大。尽管 LDL 吸附具有明确的益处，但由于其成本高且可用性低，该治疗方法存在固有局限性，因此该程序的获得仍然受到限制。
需要更好地确定有资格接受 LDL 吸附的患者人群，并制定统一的欧洲指南来管理吸附的使用。除了在适当情况下增加对吸附的获取之外，还需要新的治疗方法来进一步降低 LDL-C 并降低严重高胆固醇血症患者的持续 CVD 风险。
