First steps toward the establishment of a German low-density lipoprotein-apheresis registry: recommendations for the indication and for quality management.
New recommendations for the indication of treatment with selective extracorporeal plasma therapy low-density lipoprotein apheresis (LDL-apheresis) in the prevention of coronary heart disease are urgently needed. The following points are the first results of the ongoing discussion process for indications for LDL-apheresis in Germany: all patients with homozygous familial hypercholesterolemia with functional or genetically determined lack or dysfunction of LDL receptors and plasma LDL cholesterol levels >13.0 mmol/L (>500 mg/dL); patients with coronary heart disease (CHD) documented by clinical symptoms and imaging procedures in which over a period of at least 3 months the plasma LDL cholesterol levels cannot be lowered below 3.3 mmol/L (130 mg/dL) by a generally accepted, maximal drug-induced and documented therapy in combination with a cholesterol-lowering diet; and patients with progression of their CHD documented by clinical symptoms and imaging procedures and repeated plasma Lp(a) levels >60 mg/dL, even if the plasma LDL cholesterol levels are lower than 3.3 mmol/L (130 mg/dL). Respective goals for LDL cholesterol concentrations for high-risk patients have been recently defined by various international societies. To safely put into practice the recommendations for LDL-apheresis previously mentioned, standardized treatment guidelines for LDL-apheresis need to be established in Germany that should be supervised by an appropriate registry.
Schettler
V
V
Department of Nephrology and Rheumatology, Georg-August-University of Göttingen, Göttingen, Germany. vschett@gwdg.de
Wieland
E
E
Armstrong
V W
VW
Kleinoeder
T
T
Grunewald
R W
RW
Müller
G A
GA
D008078:Cholesterol, LDL / Q000097:blood*; D003245:Consensus Statements as Topic; D003327:Coronary Disease / Q000517:prevention & control*; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic; D016730:Program Development; D012042:Registries
D008078:Cholesterol, LDL