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Severe hypercholesterolaemia: therapeutic goals and eligibility criteria for LDL apheresis in Europe

Thompson, Gilbert Ra; Catapano, Albericob; Saheb, Samirc; Atassi-Dumont, Mariellec; Barbir, Mahmoudd; Eriksson, Matse; Paulweber, Bernhardf; Sijbrands, Ericg; Stalenhoef, Anton Fh; Parhofer, Klaus Gi

doi: 10.1097/MOL.0b013e3283402f53
Therapy and clinical trials: Edited by Anton F. Stalenhoef and John J.P. Kastelein

Purpose of review 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.

Recent findings 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.

Summary 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.

aImperial College, Hammersmith Hospital, London, UK

bInstitute of Pharmacological Sciences, University of Milan, Milan, Italy

cClinical Center of Hemobiotherapy, Pitié Salpêtrière Hospital, Paris, France

dRoyal Brompton & Harefield Hospital Trust, London, UK

eKarolinska University Hospital, Huddinge, Stockholm, Sweden

fMedizinischen Abteilung, St.-Johann-Spitals, Salzburg, Austria

gErasmus MC, University Medical Center, Rotterdam, The Netherlands

hRadboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

iKlinikum der Ludwig-Maximilians-University, Munich, Germany

Correspondence to Emeritus Professor Gilbert R. Thompson, Metabolic Medicine, Imperial College, Hammersmith Hospital, Ducane Road, London W12 0NN, UK Tel: +44 20 8994 6143; e-mail: g.thompson@imperial.ac.uk

© 2010 Lippincott Williams & Wilkins, Inc.