Experience in Using Lipid Filtration in the Combination Therapy of Familial Hypercholesterolemia

Abstract

Aim. To demonstrate the clinical efficacy of long-term lipoprotein apheresis using lipid filtration in a patient with refractory familial hypercholesterolemia and progressive atherosclerotic cardiovascular disease in whom maximally tolerated combination lipid-lowering therapy proved insufficiently effective. Key points. Familial hypercholesterolemia is one of the most common inherited causes of premature atherosclerotic cardiovascular disease and is characterized by a high risk of early cardiovascular complications. Despite the availability of modern lipid-lowering drugs, including proprotein convertase subtilisin/kexin type 9 inhibitors and inclisiran, some patients fail to achieve target low-density lipoprotein cholesterol (LDL-C) levels, necessitating additional treatments. A clinical case is presented of a 52-year-old patient with familial hypercholesterolemia and early-onset and progressive coronary artery disease, and a history of recurrent myocardial infarction and multiple endovascular interventions is presented. LDL-cholesterol targets were not achieved despite the use of maximally tolerated combination lipid-lowering therapy, which included high-intensity statins, ezetimibe, alirocumab, and inclisiran. Due to the persistently high cardiovascular risk, the patient was started on a long-term lipoprotein apheresis program using the lipid filtration modality, performed once every two weeks. Over one year, 22 procedures were performed, resulting in a marked reduction in LDL-C levels (by 75%) immediately after each session. Lipoprotein apheresis combined with multicomponent pharmacological therapy made it possible to stabilize the atherosclerotic process, prevent further major vascular events, and significantly improve the patient's quality of life. Conclusion. The presented clinical case demonstrates the importance of timely incorporation of lipid filtration into the comprehensive treatment of patients with refractory familial hypercholesterolemia when current lipid-lowering therapy regimens are insufficiently effective. Keywords: familial hypercholesterolemia, atherosclerotic cardiovascular disease, alirocumab, inclisiran, lipoprotein apheresis, cascade plasmapheresis, lipid filtration, plasmapheresis.