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IU launches lipid-lowering program.

When diet, exercise, and cholesterol-lowering medications don't work, what can one do to reduce the high risk of cardiovascular disease, heart attack, and stroke? For individuals suffering from a genetically inherited disorder called familial hypercholesterolemia (FH), there is new hope. An emerging technology offers an alternative to families with this genetic predisposition to high cholesterol, or FH.

"Lipid apheresis is a way to selectively remove the bad, or LDL, cholesterol," said Mark Deeg, M.D., Ph.D., director of the IU Vascular Health Program, professor of medicine at the Indiana University School of Medicine and investigator in the Indiana Center for Vascular Biology and Medicine. "It functions like a dialysis machine in terms of what happens. You put a needle in one arm vein, the blood comes out, a series of filters takes out the fat, and the blood returns to the patient's other arm. It is that simple."

The FDA-approved treatment--used widely in Europe for the past 20 years--is now available at nearly 20 medical centers across the United States. The newly installed equipment for the LDL Apheresis Program at Indiana University will be the first in the state.

To learn more about the benefits of lipid apheresis, Neighborhood Heart Watch interviewed Dr. Deeg, who is also associate professor of biochemistry and molecular biology at Indiana University. We also spoke with Bey Porter, the nurse coordinator for the program.

NHW: Who is eligible for lipid apheresis?

Deeg: There are two major FDA-approved indications for this machine. The first includes people with LDL levels of 300 or more despite medical therapy. Most of these people will have familial hypercholesterolemia. Another is therapy for patients with heart disease who are unable to reduce their LDL cholesterol levels below 200 with diet and medications. Most of these candidates also have familial hypercholesterolemia.

NHW: Does insurance cover the treatment?

Deeg: Most private insurance companies cover the treatment. It is approved for Medicare coverage as well.

NHW: Would individuals with FH then have to undergo lifelong therapy?

Deeg: Yes, unless a gene therapy becomes available someday. Patients are treated with apheresis every two weeks. We begin by inserting a needle in the arms. After a year or two, we place a small shunt in the forearm. After treatment with apheresis, cholesterol levels drop acutely, then rebound. By continuing on the statin or other cholesterol-controlling medications, people can limit how fast the levels come back up.

NHW: How much does apheresis lower the LDL level?

Deeg: One treatment will acutely lower LDL level some 60 percent. Not only does the treatment lower LDL, it also lowers two other important risk factors for cardiovascular events. One is the inflammatory marker called C-reactive protein. The treatment also reduces fibrinogen and plasma viscosity. When you have a heart attack, a clot forms. By lowering fibrinogen levels, you reduce the ability to form a clot.

NHW: Are researchers investigating the potential of this therapy to treat other conditions?

Deeg: Yes. Some very exciting research was recently published in the Lancet in regard to acute hearing loss. Another trial in process will help determine whether one-time apheresis improves outcome in patients with heart attacks and unstable angina. In addition, we are going to try to get a trial going at Indiana University using the therapy in cardiac transplantation patients who experience accelerated atherosclerosis.

Welcome Aboard, Keith March, M.D., Ph.D.

A brilliant and prodigious researcher and inventor, Dr. Keith March joins our newsletter staff as editor of the Indiana Center for Vascular Biology and Medicine news page. Dr. March is director of the Indiana Center for Vascular Biology and Medicine (ICVBM) at the IU School of Medicine. ICVBM focuses on the study and treatment of vascular diseases.

Blood vessels course throughout the entire body, feeding the body's tissues with oxygen-rich blood, and play a major role in such conditions as heart attacks, strokes, peripheral vascular disease, hypertension, kidney disease, and diabetes. Tapping into the latest developments in genetic research and molecular biology, ICVBM is committed to being a leader in basic and applied research to develop a greater understanding of--and novel therapies for--heart and other vascular related problems.

Dr. March and his team of nearly 30 investigators will report on their research in the areas of cutting-edge medical therapies to improve the care of patients with vascular problems. Future issues will keep readers abreast of latest research as it occurs at the Center and elsewhere from a range of basic, as well as clinical, disciplines, using advances in genomics and molecular biology. This issue features Dr. Mark Deeg, a pilot project investigator for the ICVBM.

For more information about the Center and current research efforts, contact Dr. Keith March at 317-278-0130 or e-mail:
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Title Annotation:Neighborhood Heart Watch
Author:March, Keith
Publication:Medical Update
Geographic Code:1USA
Date:Feb 1, 2003
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