Arterioscler Thromb Vasc Biol. 2024 Dec;44(12):e304-e321. doi: 10.1161/ATV.0000000000000177. Epub 2024 Oct 7.
Despite the availability of multiple classes of lipoprotein-lowering medications, some high-risk patients have persistent hypercholesterolemia and may require nonpharmacologic therapy. Lipoprotein apheresis (LA) is a valuable but underused adjunctive therapeutic option for low-density lipoprotein cholesterol and lipoprotein(a) lowering, particularly in children and adults with familial hypercholesterolemia. In addition to lipid lowering, LA reduces serum levels of proinflammatory and prothrombotic factors, reduces blood viscosity, increases microvascular myocardial perfusion, and may provide beneficial effects on endothelial function. Multiple observational studies demonstrate strong evidence for improved cardiovascular outcomes with LA; however, use in the United States is limited to a fraction of its Food and Drug Administration-approved indications. In addition, there are limited data regarding LA benefit for refractory focal segmental glomerulosclerosis. In this scientific statement, we review the history of LA, mechanisms of action, cardiovascular and renal outcomes data, indications, and options for treatment.
尽管有多种类别的降脂药物可供使用，但一些高危患者仍存在持续性高胆固醇血症，可能需要非药物治疗。脂蛋白吸附（LA）是一种有价值但未充分利用的辅助治疗选择，可降低低密度脂蛋白胆固醇和脂蛋白（a）水平，尤其适用于儿童和成人家族性高胆固醇血症患者。除了降低血脂外，LA 还可降低促炎和促血栓形成因子的血清水平，降低血液粘度，增加微血管心肌灌注，并可能对内皮功能产生有益影响。多项观察性研究证明 LA 可显著改善心血管结局；然而，在美国，LA 的使用仅限于其获得食品和药物管理局批准的适应证的一小部分。此外，关于 LA 对难治性局灶节段性肾小球硬化的益处的数据有限。在这份科学声明中，我们回顾了 LA 的历史、作用机制、心血管和肾脏结局数据、适应证以及治疗选择。
