Contrast-Enhanced Ultrasound Reveals That Lipoprotein Apheresis Improves Myocardial But Not Skeletal Muscle Perfusion

Apheresis is a consolidated procedure for removing low-density lipoprotein (LDL) cholesterol subparticles from blood. It is clinically useful in patients with very elevated cholesterol levels, as in familial hypercholesterolemia, an inherited disorder with a reduced liver uptake of LDL due to scarce or malfunctioning receptors. This extends the half-life of LDL particles, conferring them an increased susceptibility to oxidation if a strong oxidative drive is present in the blood, linked mainly to obesity, diabetes, smoking, chronic infections, pesticides, and elevated homocysteine, heavy metals, and trans-fatty acids. Thus, highly oxidized or minimally modified LDL (not the LDL particles themselves) interfere with endothelial nitric oxide production, hampering vasodilation and fostering endothelial dysfunction. These patients have a higher rate of cardiovascular events at an earlier age. [...]