LDL-apheresis

LDL-apheresis is a treatment that removes the cholesterol from your blood. It works a lot like dialysis. Your blood is passed through a machine which filters out the cholesterol and is returned to your body.

It’s a life-saving treatment which can be used for people with very high cholesterol levels which can’t be brought down with medicines and diet. It’s usually used for people with high cholesterol that’s caused by their genes, such as in familial hypercholesterolemia (FH).

By bringing very high cholesterol levels down, LDL-apheresis helps stop cholesterol from being laid down in the arteries, which clogs them up and leads to heart disease and stroke.

Who can have LDL-apheresis?

LDL is used in a small number of people who are at higher risk of developing health problems.

LDL-apheresis could be an option for you, if:

  • you have high cholesterol and medicines and diet haven’t brought your cholesterol down low enough, or the medicines are side effects
  • you have an inherited form of high cholesterol, such as familial hypercholesterolemia (FH), and your cholesterol is still too high with medicines
  • you have the form of FH where you inherit a faulty gene from each parent (homozygous or compound heterozygous FH) which raises cholesterol higher
  • you have raised levels of a blood fat called Lp(a) and have signs of heart disease even with medicines.
  • LDL-apheresis can be used for treating children. It means it’s possible to stop high cholesterol from causing damage at an early age. This is important for people with FH with two faulty genes, which can cause heart disease in early adulthood if it isn’t treated.

LDL-apheresis is done in lipid clinics which are based in some hospitals, and in some renal (kidney) units and NHS Blood and Transplant Centres.

You’ll need to go to the centre for treatment once every one to two weeks, and it will take two to four hours, although this varies.
Having the treatment is a lot like dialysis.

You’ll sit back in a chair or couch, or lay down on a bed. You’ll have a needle placed in a vein in your arm so that some of your blood can pass through a tube into a machine. Some of your cholesterol is removed by the machine and your blood is returned to your body.
The treatment doesn’t hurt, though sometimes it can be hard to find a vein which can make it uncomfortable.

There are different types of LDL-apheresis machines and they can work in a few different ways. Some use filters to sift the cholesterol out of your blood, while others use special solutions. Your team will decide which one is right for you. The procedure removes the LDL cholesterol (bad cholesterol) from your blood, and other blood fats too. It removes another type of cholesterol called Lp(a) and triglycerides.

The treatment can lower your LDL cholesterol and LP(a) by 60-75%, making a big difference to your cholesterol levels. They do rise again quite quickly, which is why you need to have treatment every one or two weeks.

Your cholesterol levels in between treatments give a good idea of your cholesterol levels overall and how well the treatment is working.

Getting ready for treatment

You will probably keep taking your other medicines at the same time as having LDL-apheresis, but your doctor will talk to you about any changes.

Before each treatment you will be given a medicine to thin your blood which makes it easier for the machines to do their job.

You will need to stop taking any medicines for high blood pressure on the day of your treatment, but start taking it again as normal the next day. If you’re taking ACE inhibitors you’ll probably need to switch to another high blood pressure medicine.

Are there any side effects?

You might have some side effects for the first few treatments, but they tend to go away as your body gets used to it. Apheresis is a safe procedure and doesn’t usually cause any long-term side effects, and when there are side effects they tend to be mild.

There will be nurses with you while you’re having treatment. They will keep an eye on you and will be able to deal with any problems or side effects.

Feeling tired is one of the most common problems. Most people find they’re back to normal after a good night’s sleep, or even a quick snooze, but for others it can take a few days.

 

 LDL apheresis toolkit for healthcare professionals

LDL-apheresis isn’t widely used and it’s often not well understood, so we’ve put together a toolkit for health professionals, commissioners and people having treatment. It explains how the treatment works, who it’s suitable for, how people can be referred for treatment and the sites where it’s available in the UK.