Mar. 2, 2004 Traditional medications were not enough to lower Renee Reinke’s sky-high cholesterol level. But preventive cardiologists at the University of Michigan Health System were able to offer the 52-year-old an alternative.
Cholesterol apheresis is a blood-filtering technique similar to kidney dialysis that strips the blood of LDL cholesterol to help lower the levels of this artery-clogging substance. UMHS is one of a handful of centers across the country, and the only one in Michigan, to offer this technique.
“The cholesterol-lowering medications were not bringing me down to a safe level,” Reinke says. “The cardiologists hope this will prevent more blockages and possibly help the blockages I have already. So it was the only thing left.”
The technique is not a first-line treatment for people with high cholesterol. Initially, patients are encouraged to lose weight, follow a healthy diet, exercise more or take any of several lipid-lowering medications. For approximately one in 300,000 people, these methods aren’t enough to achieve the goal.
There are two types of cholesterol in our blood: low density lipoprotein, or LDL, and high density lipoprotein, or HDL. LDL is know as the “bad” cholesterol because it sticks to the lining of the blood vessels, narrowing them and raising the risk of heart attack, stroke or angina pain. High levels of LDL cholesterol are linked to an increased risk of dying from cardiovascular disease. HDL cholesterol, on the other hand, actually removes harmful cholesterol from the blood vessels
Patients receive cholesterol apheresis treatment once every two to three weeks. A catheter is placed in one arm to drain the blood. The machine separates the red and white blood cells from the plasma. The LDL is then removed from the plasma and the plasma is returned back to the body with the patient’s own blood cells. Because the patient’s own blood is returned, there’s no risk for external infections. The procedure takes about two to three hours.
“Typically we reserve LDL apheresis for patients who have failed lifestyle changes and multiple drugs to achieve their goals for LDL cholesterol. It’s not a first line therapy in anybody because there are many other options, including lifestyle changes, weight loss, diet and multiple medications to achieve the goal,” says Robert Brook, M.D., a hypertension and vascular specialist at UMHS and assistant professor of internal medicine at the U-M Medical School.
For those people who do require cholesterol apheresis, it is highly effective. Studies indicate it lowers the risk of cardiovascular events by 50 percent to 70 percent, compared to patients receiving traditional therapy.
LDL apheresis may be indicated for people whose LDL levels are higher than 300 mg/dl or for those with coronary heart disease whose LDL levels are 200 mg/dl or higher. It is only used if the patient cannot lower his or her cholesterol through lifestyle changes and medications or if the medications are not tolerated.
For Renee Reinke, who has had bypass surgery and has a strong family history of heart disease, cholesterol apheresis has given her hope of avoiding further heart problems.
“My biggest hope is that I won’t get more blockages that could cause heart attack or stroke,” Reinke says. “I’ve watched my dad and my grandmother go through heart attacks and stroke, and I just hope that I never have to.”
Total cholesterol, as well as LDL and HDL levels, are important to consider. Recommended total cholesterol ranges:
• Less than 200 – good • 200-239 – borderline high • 240 or above – high
Cardiologists recommend HDL levels of 45 mg/dl or higher.
Recommended LDL levels vary depending on your risk:
• Less than 160 – for most people • Less than 130 – for people with increased risk of heart disease • Less than 100 – for people with heart disease, diabetes, peripheral artery disease, abdominal aortic aneurysm or symptomatic carotid artery disease
Keeping cholesterol low:
Most people can control their cholesterol through lifestyle changes, such as eating right, exercising, and not smoking. Here are some tips:
• Eat fruits, vegetables, beans and whole grains every day. • Avoid foods high in fat, especially saturated fat, such as butter or meat. • Look for healthier polyunsaturated and monounsaturated fats. • Use oils like sunflower, safflower, canola, olive and corn instead of palm or coconut. • Choose chicken, turkey or fish over red meat. • Use egg whites instead of whole eggs. • Replace whole milk dairy with nonfat or low-fat milk, cheese, or yogurt. • Reduce fried foods, vending machine choices, and fast food. • Exercise at least 20 minutes every other day. Try swimming, jogging, walking, or bicycling. • Have your cholesterol levels checked once a year.
More information on cholesterol:
U-M Health Topics A-Z: Cholesterol http://www.med.umich.edu/1libr/guides/choles.htm
U-M Health Topics A-Z: High cholesterol http://www.med.umich.edu/1libr/aha/aha_hyc_crs.htm
U-M Cardiovascular Center: Lipid Management Services http://www.med.umich.edu/cvc/adult/prelip.htm
American Heart Association: LDL vs. HDL cholesterol http://www.americanheart.org/presenter.jhtml?identifier=180
Medline Plus: Familial hypercholesterolemia http://www.nlm.nih.gov/medlineplus/ency/article/000392.htm
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