{"id":"2694caa74d58","type":"article","url":"https://hartvaat.nl/2026/05/19/lipoproteine-aferese-blijft-relevant-in-het-tijdperk-van-pcsk9-remmers-en-sirna/","title":"Lipoproteïne-aferese blijft relevant in het tijdperk van PCSK9-remmers en siRNA","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["abelacimab","cetp-remmers","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","obicetrapib","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","pelacarsen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag328","source_url":"https://doi.org/10.1093/eurheartj/ehag328","authors":["Francesco Sbrana","Beatrice Dal Pino","Volker J J Schettler","Eri Muso","Mariko Harada-Shiba","Maria Di Mola","Maki Kagitani","Eleanor Pineda","Nathalie Selke","Sebastian Jenke","Thomas Zimmermann","Wanja Bernhardt","Federico Bigazzi","Franz Heigl","Peter Grützmacher","Iris Löhlein","Reinhard Klingel","Carmen Corciulo","Bernd Hohenstein","Wolfang Ramlow","Anja Vogt","Alfonso Ramunni","Michele Emdin","Tiziana Sampietro","Ulrich Julius","Georg Schlieper","Claudia Stefanutti","Patrick M Moriarty"],"significance":6,"published":"2026-06-12","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/","https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/"],"congress":"","summary_en":"Review of lipoprotein apheresis (LA) in the era of modern lipid-lowering therapies. LA selectively removes atherogenic apoB100-containing lipoproteins — LDL, VLDL, and lipoprotein(a) — from blood. Proven effects: protection of endothelium and microcirculation, prevention of new aortic and coronary lesions in homozygous familial hypercholesterolaemia (HoFH), reduction of cardiovascular events, and adjunct in secondary prevention for patients who fail LDL targets or have elevated Lp(a). Despite the rise of PCSK9 inhibitors, antisense oligonucleotides, and siRNA therapies, LA remains a safe option for patients with severe lipid disorders. Barriers to broader use: HoFH and high-Lp(a) underdiagnosis, therapeutic inertia, and limited availability of qualified LA centres. Future research is directed at kidney disease, peripheral arterial disease, pre-eclampsia, macular degeneration, and sudden sensorineural hearing loss.","created":"2026-07-03T10:33:02Z","updated":"2026-07-03T13:31:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Overzichtsartikel over de rol van lipoproteïne-aferese (LA) naast moderne lipidenverlagende therapieën. LA verwijdert selectief atherogene apoB100-bevattende lipoproteïnen — LDL, VLDL en lipoproteïne(a) — uit het bloed. Bewezen effecten: bescherming van endotheel en microcirculatie, voorkomen van nieuwe aorta- en coronairlaesies bij homozygote familiaire hypercholesterolemie (HoFH), reductie van cardiovasculaire events, en aanvulling op secundaire preventie bij patiënten die LDL-doelen niet halen of verhoogd Lp(a) hebben. Ondanks de opkomst van PCSK9-remmers, antisense-oligonucleotiden en siRNA-therapieën blijft LA een veilige optie voor patiënten met ernstige lipidenstoornissen. Belemmeringen voor brede toepassing: onderdiagnostiek van HoFH en hoog Lp(a), therapeutische inertie en beperkte beschikbaarheid van gekwalificeerde LA-centra. Toekomstig onderzoek richt zich op nierziekte, perifere arteriële ziekte, pre-eclampsie, maculadegeneratie en plots gehoorverlies.","abstract_original":"During the 1960s, in a pioneering way, plasmapheresis was used to treat children with homozygous familial hypercholesterolaemia (HoFH). Over the years, apheresis has evolved to increasingly selective methods, which have been used in paediatric HoFH since the 1990s. Today, lipoprotein apheresis (LA) is able to selectively remove atherogenic apoB100-containing lipoproteins from the blood: the main component of LDL-cholesterol, VLDL-cholesterol, and lipoprotein(a). Lipoprotein apheresis has demonstrated protective effects in the endothelium and microcirculation, prevention of the development of new aortic and coronary lesions in HoFH, reducing the incidence of major cardiovascular events, and proving helpful in subjects who fail to reach the LDL-cholesterol target or who have elevated lipoprotein(a) levels in secondary prevention. Although advances in pharmacological therapies (proprotein convertase subtilisin/kexin Type 9 inhibitors, antisense oligonucleotides, and siRNA-based treatments) have expanded the options for lipid management, LA remains a safe therapeutic approach for patients with severe lipid disorders, including HoFH, to reduce their cardiovascular risks. Currently, to put LA into perspective, some obstacles need to be overcome, including (i) the underdiagnosis of HoFH and high lipoprotein(a) level; (ii) therapeutic inertia resulting from the use of new lipid-lowering drugs with partial achievement of lipid targets; and (iii) availability of qualified LA centres and practitioners. Further prospective studies may prove useful to identify other therapeutic scenarios for LA, such as renal disease, diabetic foot ulcer, peripheral arterial disease, pre-eclampsia, macular degeneration, or sudden sensorineural hearing loss. In these clinical settings, prospective, randomized clinical trials are therefore warranted."}