LDL Apheresis Program

Program Overview

Over the past twenty years, preventive cardiology trials have shown that a lower LDL cholesterol (bad cholesterol) is associated with fewer heart attacks and strokes. But how low is low enough? Aggressive preventive cardiologists at the Minneapolis Heart Institute are now pushing patients with known disease to “sub-physiologic levels” of LDL cholesterol to prevent recurrence of heart attacks and strokes. That means an LDL cholesterol of less than 70 mg/dl and oftentimes sitting at 50 mg/dl or less.

“Most people are born with an LDL cholesterol of 35 mg/dl,”said cardiologist Kevin J. Graham, MD, president of the Minneapolis Heart Institute at Abbott Northwestern Hospital and director of Preventive Cardiology. “Through many studies over the years, we have proved that it is safe and effective to lower LDL cholesterol towards those birth levels in high risk adults to prevent heart attacks and strokes.”

But what about when diet, exercise, and cholesterol-lowering medications don't work? What can be done to reduce the high risk of cardiovascular disease, heart attack, and stroke in these patients? For 18 years, the Minneapolis Heart Institute has participated in a unique research and treatment program for individuals suffering from a genetically inherited disorder called familial hypercholesterolemia (FH). This powerful treatment program uses technology called lipid apheresis. And in the era of “lower is better,” this technology is again coming into the cholesterol spotlight.

Essentially, lipid apheresis is dialysis for LDL cholesterol. The apheresis procedure is initiated by drawing blood from one arm vein into the apheresis device where the LDL cholesterol is removed from the blood through a series of filters. The remaining plasma and cells are then returned to the patient through another vein.

During the procedure, it is not uncommon for LDL cholesterol levels to drop from greater than 250 mg/do to 35 mg/dl. With apheresis, other injurious proteins are also cleansed from the blood (C reactive protein and fibrinogen), resulting in a decrease in the blood’s viscosity (stickiness). Levels rebound between procedures, so it is necessary to repeat the treatments every two to four weeks to keep levels under reasonable control. Apheresis combined with powerful cholesterol lowering medications offers stabilization of coronary artery disease for patients with FH who previously had limited treatment options.

The Minneapolis Heart Institute at Abbott Northwestern Hospital’s apheresis program has been a dedicated collaboration between cardiologists, nephrologists, technicians, and patients over the last two decades. Tom Davin, MD, a nephrologist with Abbott Northwestern Hospital, and his team of technicians have collaborated with MHI to offer this lifesaving service.

Patient Larry Schroeder had his first heart attack at age 28. Schroeder has FH and was intolerant of many cholesterol lowering medications. He has now had 655 apheresis treatments over the last 18 years—first as part of an MHI research trial, then as a grateful patient.

“The reason I am here today is because of the great doctors, nurses and technicians,” said Schroeder. “This procedure has clearly kept me alive.” Schroeder turned 61 years old this year and is still enjoying life fully.

The Minneapolis Heart Institute’s apheresis program is one of twenty programs nationally and the only one in this region. Most private insurance companies cover the treatment and it is approved by Medicare, as well. Apheresis requires a dedicated patient willing to undergo the rigors of twice-monthly treatments for life. But for those patients with severe genetic cholesterol disorders that are resistant to drug therapy, it offers a lifesaving alternative—and hope. It is another great example of how a high-tech procedure was validated through research at the Minneapolis Heart Institute, only to quietly become a lifesaving treatment appropriately offered to qualified patients.