Dr. Sanchez: In general, if people don’t have risk factors, the goal LDL would be less than 160. If someone actually has heart disease then the goal is less than 70 for an LDL. For people who qualify for this procedure, their LDLs are in the 200 to 300 or even higher range.

What is the highest you have personally seen?

Dr. Sanchez: In the 300s.

Was that a shock for you? 

Dr. Sanchez: Well, it is very high. This procedure is specifically for those people; people who have severely high cholesterol. Probably most of these people have genetic risk factors for high cholesterol and the medications that are available aren’t going to bring it down enough to reduce their risk for heart disease.

Without apheresis, what would happen to these people? 

Dr. Sanchez: Without this procedure, most likely their coronary disease would worsen over time and they are more at risk for more heart attacks.

What is LDL apheresis? 

Dr. Sanchez: LDL apheresis is a procedure that is performed about once every 2 weeks. Usually it is done with peripheral IVs placed in the arms. The blood exits the body, goes through a filter that separates the plasma from the blood which is the part of the blood that contains all the cholesterol. The plasma portion is then run through a special filter that just absorbs bad cholesterol and returns all the good cholesterol, all the other plasma proteins back to the patient.

Is this like dialysis for the blood? 

Dr. Sanchez: It is similar to dialysis in that it is a process that cleans the blood. However, it only has to be done once every 2 weeks. If someone can be on cholesterol medications and continues a healthy lifestyle and diet, they can spread the treatments out further. It is considered a lifelong therapy unless new medications are available that could treat their cholesterol appropriately and that could be tolerated by the patient who is intolerant to current medications.

How long do they have to stay on the IV each time?

Dr. Sanchez: A typical procedure lasts about 3 to 4 hours.

From that fresh start, if you ate healthy, exercised, would you LDL shoot back up?

Dr. Sanchez: What happens is with one procedure the cholesterol will go down 70 to 80%, but then after you leave your liver continues to make cholesterol on a daily basis. So in those 2 weeks, even if at the end of the treatment you leave with LDL cholesterol of 60, in 2 weeks it might be back up into the 200s. So it is important that patients who do this procedure keep coming regularly, keep a healthy diet, and keep taking medications if they can tolerate them.

They are still going to creep up to 300 LDL? 

Dr. Sanchez: Yes. For people who are genetically predisposed to high LDL cholesterol, the liver will continue to generate. For many of them, the problem is that the body is just not clearing the LDL cholesterol that the body is making. 

What is the average age they first come to you?

Dr. Sanchez: We have been referred patients as young as 15 and as old as 74. 

Now for those ones who are 74, have they always had this problem because their livers have always made it or is it something that gets worse over time?

Dr. Sanchez: Most people that qualify for this procedure are people that have had long-standing high cholesterol.

How long has this been around and have they just never been to a facility that had this?

Dr. Sanchez: There have been procedures available to reduce cholesterol since the early 70s. However, most of them have been very nonspecific and remove all of the plasma proteins not just the bad cholesterol. The type of LDL apheresis that we perform just removes the bad cholesterol, returning the good cholesterol to the patient. Now this technology has been available since the 80s, but only FDA approved since the 1990s. The reason that it has been an exciting procedure is that there are not many centers in the US that have the nurses and physicians who are trained in how to provide this procedure for patients. There are currently only about 60 centers in the US who perform LDL apheresis at all. So there are many patients who don’t live near a center, many cities that don’t have this technology available, and it is something that is an important complement to treating a patient with heart disease and with high cholesterol.

How long has Sandra been doing this and when you first saw her, what was she like?

Dr. Sanchez: I first met Ms. Miller about 6 months ago and I remember her story very clearly because she had had a cardiac catheterization probably in the 90s and she had known that she had high cholesterol all her life. When she had this cardiac catheterization, she was actually told she had a clean bill of health and everything looked great. So, she stopped worrying about her high cholesterol. She had tried diet all her life to reduce her cholesterol, she had also tried every single medication on the market but had not tolerated the side effects of the medications. Then a few years ago, she had her first heart attack. She had gotten a false sense of security by her negative catheterization years ago and during this time, cholesterol is building up in her arteries. So she is someone that this procedure is really important for because it is going to help prevent her heart disease from getting worse and perhaps reverse some of the plaque buildup that is already in her heart.