title: Use of ultra high performance liquid chromatography-tandem mass spectrometry to demonstrate decreased serum statin levels after extracorporeal LDL-cholesterol elimination.
abstract: BACKGROUND
  Using our statin analysis method, it was possible to uncover a significant drop in statin levels (atorvastatin, simvastatin, and metabolites) after extracorporeal LDL-cholesterol elimination (EE) in severe familial hypercholesterolemia (FH). The purpose of this work was to identify the mechanism underlying this drop and its clinical significance as well as to propose measures to optimize a pharmacotherapeutical regimen that can prevent the loss of statins.
  
  
  METHODS
  Ultra High Performance Liquid Chromatography (UHPLC) connected to the triple quadrupole MS/MS system was used. Patients. A group of long-term treated patients (3-12 years of treatment) with severe FH (12 patients) and treated regularly by LDL-apheresis (immunoadsorption) or haemorheopheresis (cascade filtration) were included in this study.
  
  
  RESULTS
  After EE, the level of statins and their metabolites decreased (atorvastatin before/after LDL-apheresis: 8.83/3.46 nmol/l; before/after haemorheopheresis: 37.02/18.94 nmol/l). A specific loss was found (concentration of atorvastatin for LDL-apheresis/haemorheopheresis: 0.28/3.04 nmol/l in washing fluids; 11.07 nmol/l in filters). To prevent substantial loss of statin concentrations, a pharmacotherapeutic regimen with a longer time interval between the dose of statins and EE is recommended (15 hours).
  
  
  CONCLUSIONS
  A specific loss of statins was found in adsorbent columns and filters. The decrease can be prevented by the suggested dosage scheme.
authors.affiliation: 2nd Department of Internal Medicine, Hematology, Medical Faculty and Teaching Hospital, Charles University, Hradec Králové, Czech Republic. blaham@email.cz
authors.forename: M
authors.initials: M
authors.lastname: Bláha
authors.forename: H
authors.initials: H
authors.lastname: Vlcková
authors.forename: L
authors.initials: L
authors.lastname: Nováková
authors.forename: D
authors.initials: D
authors.lastname: Solichová
authors.forename: P
authors.initials: P
authors.lastname: Solich
authors.forename: M
authors.initials: M
authors.lastname: Lánská
authors.forename: J
authors.initials: J
authors.lastname: Malý
authors.forename: V
authors.initials: V
authors.lastname: Bláha
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents / Q000097:blood* / Q000378:metabolism; D000069059:Atorvastatin; D001781:Blood Component Removal / Q000379:methods; D008078:Cholesterol, LDL / Q000302:isolation & purification*; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D005260:Female; D006440:Hemofiltration / Q000379:methods; D006538:Heptanoic Acids / Q000097:blood* / Q000378:metabolism; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood* / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000097:blood* / Q000378:metabolism; D019821:Simvastatin / Q000097:blood* / Q000378:metabolism; D018709:Statistics, Nonparametric; D053719:Tandem Mass Spectrometry / Q000379:methods
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin