Apheresis in homozygous familial hypercholesterolemia: The results of a follow-up of all Norwegian patients with homozygous familial hypercholesterolemia

BackgroundHomozygous familial hypercholesterolemia (HoFH), which affects 1 in a million individuals, leads to extremely elevated levels of cholesterol and early-onset cardiovascular disease.ObjectiveThe aim of this study was to assess all 7 HoFH patients treated with low-density lipoprotein (LDL) apheresis in Norway with respect to quality of life, clinical and laboratory assessments, and cardiovascular status.MethodsApheresis treatment and assessment of cardiovascular status was performed at local hospitals but coordinated by the Lipid Clinic that has followed all patients since diagnosis. Quality of life was evaluated by a validated questionnaire.ResultsResults are shown as median (min-max). LDL cholesterol at diagnosis (untreated) was 704 (592–1268) mg/dL (18.2 [15.3–32.8] mmol/L). Medication was initiated at age 9 (2–35) years, and apheresis treatment at age 10 (6–44) years. Regular once-weekly apheresis combined with the maximum-tolerable doses of a statin and ezetimibe reduced LDL cholesterol to 197 (170–282) mg/dL (5.1 [4.5–7.3] mmol/L) pre-apheresis and 85 (50–108) mg/dL (2.2 [1.3–2.8] mmol/L) post-apheresis. Calculated interval mean LDL cholesterol was 162 (135–220) mg/dL (4.2 [3.5–5.7] mmol/L). Duration of apheresis treatment was 11 (1–24) years. Cardiovascular manifestations progressed in most patients despite the apheresis treatment. The subjects’ quality of life was comparable with that of a healthy population, with the exception of two patients, who were significantly affected by coronary disease.ConclusionsWell-tolerated, once-weekly LDL apheresis achieves lower interval mean LDL cholesterol levels between apheresis treatments than previously reported for apheresis every second week. However, progressions of cardiovascular manifestations still occurred, which highlights the importance of earlier and even more aggressive treatment and follow-up in HoFH.