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Clinical Research in Cardiology Supplements

Detlev Willemsen, C Cordes, B Bjarnason-Wehrens, E Knoglinger, E Langheim, R Marx, N Reiss, T Schmidt, A Workowski, P Bartsch, C Baumbach, C Bongarth, H Phillips, R Radke, M Riedel, S Schmidt, E Skobel, C Toussaint, J Glatz
The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication)...
March 2016: Clinical Research in Cardiology Supplements
Hermann Reichenspurner
No abstract text is available yet for this article.
March 2016: Clinical Research in Cardiology Supplements
Bilgen Kurt, Muhidien Soufi, Alexander Sattler, Juergen R Schaefer
Lipoprotein(a) (Lp(a)) was first described by K. Berg and is known for more than 50 years. It is an interesting particle and combines the atherogenic properties of low-density lipoprotein (LDL)-cholesterol as well as the thrombogenic properties of plasminogen inactivation. However, due to technical problems and publication of negative trials the potential role of Lp(a) in atherosclerosis was severely underestimated. In recent years our understanding of the function and importance of Lp(a) improved. Interventional trials with niacin failed to demonstrate any benefit of lowering Lp(a); however, several studies confirmed the residual cardiovascular disease (CVD) risk of elevated Lp(a)...
April 2015: Clinical Research in Cardiology Supplements
Gerd Schmitz, Evelyn Orsó
Lipoprotein (a) [Lp(a)] is a modified LDL particle with an additional apolipoprotein [apo(a)] protein covalently attached by a thioester bond. Multiple isoforms of apo(a) exist that are genetically determined by differences in the number of Kringle-IV type-2 repeats encoded by the LPA gene. Elevated plasma Lp(a) is an independent risk factor for cardiovascular disease.The phenotypic diversity of familial Lp(a) hyperlipidemia [Lp(a)-HLP] and familial hypercholesterolemia [FH], as defined risks with genetic background, and their frequent co-incidence with additional cardiovascular risk factors require a critical revision of the current diagnostic and therapeutic recommendations established for isolated familial Lp(a)-HLP or FH in combination with elevated Lp(a) levels...
April 2015: Clinical Research in Cardiology Supplements
Dieter Horstkotte
No abstract text is available yet for this article.
April 2015: Clinical Research in Cardiology Supplements
P Grützmacher, C Kleinert, C Dorbath, B Öhm
Lipid apheresis is at present well established in routine treatment of diverse hyperlipoproteinemias refractory to conventional dietary and medical regimens, especially in countries with high medical and socioeconomic standards. Severe familial hypercholesterolemia with atherosclerotic vessel disease involving the coronary arteries is the most frequent indication for lipid apheresis as well as homozygous familial hypercholesterolemia before the development of cardiovascular complications.In hyperlipoproteinemia (a) with progressive vessel disease, lipid apheresis is regularly accepted in Germany...
April 2015: Clinical Research in Cardiology Supplements
Franz Heigl, Reinhard Hettich, Norbert Lotz, Harduin Reeg, Tobias Pflederer, Dirk Osterkorn, Klaus Osterkorn, Reinhard Klingel
Low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp(a)) are established causal risk factors for cardiovascular disease (CVD). Efficacy, safety, and tolerability of lipoprotein apheresis (LA) were investigated in 118 patients with CVD covering a period with 36,745 LA treatments in a retrospective, monocentric study. Indications for LA were severe hypercholesterolemia (n = 83) or isolated Lp(a) hyperlipoproteinemia (Lp(a)-HLP) (n = 35). In patients with hypercholesterolemia, initial pre-LA LDL-C was 176...
April 2015: Clinical Research in Cardiology Supplements
K-P Mellwig, C Schatton, B Biermann, T Kottmann, D Horstkotte, F van Buuren
The clinical relevance of lipoprotein(a) (Lp(a)) as a cardiovascular risk factor is currently underestimated. The aim of our study was to assess the influence of increased Lp(a) values on the development and severity of coronary artery disease (CAD).In our retrospective analysis of 31,274 patients, who were hospitalized for the first time, we compared patients with isolated increased Lp(a) (> 110 mg/dl) and normal Lp(a) (< 30 mg/dl), with increased Lp(a) concentrations (30-60 mg/dl, 61-90 mg/dl, 91-110 mg/dl), and in a third analysis with additionally increased LDL cholesterol and HbA1c values...
April 2015: Clinical Research in Cardiology Supplements
Frank van Buuren, Julia Alexia Sommer, Tanja Kottmann, Dieter Horstkotte, Klaus Peter Mellwig
BACKGROUND: Elevated lipoprotein(a) (Lp(a)) levels are an accepted risk factor for coronary heart disease. The role of Lp(a) in the development of extracardiac arteriosclerosis like peripheral arterial disease (PAD) and stenosis of the arteria carotis (ACIS) has hardly been documented so far. We aimed to investigate the incidence of extracardiac arteriosclerosis in individuals with elevated Lp(a) values. METHODIK: In our center, we measured Lp(a) levels in 31,734 consecutive patients over 5 years...
April 2015: Clinical Research in Cardiology Supplements
Volker J J Schettler, Class L Neumann, Christian Peter, Thomas Zimmermann, Ulrich Julius, Eberhard Roeseler, Franz Heigl
BACKGROUND: The German Lipoprotein Apheresis Registry (DLAR) has been initiated by members of the Nephrology Foundation (WiNe), the German association of kidney centres (DN), the German society of nephrology (DGfN) and additional medical associations taking part in the apheresis working group. Its goal is the introduction of a substantial database, suitable to provide statistical evidence for the assessment of extracorporeal procedures. Data have been added to the DLAR since October 2011...
April 2015: Clinical Research in Cardiology Supplements
Reinhard Klingel, Andreas Heibges, Cordula Fassbender
Elevated lipoprotein(a) (Lp(a)) has emerged as an important independent cardiovascular risk factor, and causal association has been accepted with adverse outcome in atherosclerotic disease. Lipoprotein apheresis (LA) can lower low-density lipoprotein (LDL)-cholesterol and Lp(a) by 60-70 % and is the final escalating therapeutic option in patients with hyperlipoproteinemias (HLP) involving LDL or Lp(a) particles. Major therapeutic effect of LA is preventing cardiovascular events. Stabilizing plaque morphology might be an important underlying mechanism of action...
April 2015: Clinical Research in Cardiology Supplements
Peter Grützmacher, Claudius Kleinert
For long-term lipid apheresis therapy, several different technical systems have been developed which enable effective reduction of LDL cholesterol and other atherogenic lipoproteins, such as Lp(a), with sufficient selectivity and good clinical tolerance. Suitable techniques include whole blood adsorption with polyacrylamide and dextran sulfate cellulose, while primary plasma separation is used for cascade filtration, heparin-induced precipitation, immunoadsorption, silicate gel adsorption, and dextran sulfate cellulose (both techniques)...
June 2012: Clinical Research in Cardiology Supplements
Peter Schuff-Werner, Sebastian Fenger, Peter Kohlschein
During the last decades, LDL-apheresis was established as an extracorporeal treatment option for patients with severe heterozygous or homozygous familial hypercholesterolemia (FH) that is resistant to conventional treatment strategies such as diet, drugs, and changes in lifestyle. Nearly half a century ago, the first LDL-apheresis treatment was performed by plasma exchange in a child with homozygous FH. At the beginning of the 1970s, the clinical advantage of regular extracorporeal LDL-elimination was demonstrated in siblings suffering from homozygous FH...
June 2012: Clinical Research in Cardiology Supplements
Prof Dr Med D Horstkotte
No abstract text is available yet for this article.
June 2012: Clinical Research in Cardiology Supplements
Frank van Buuren, Sven Kreickmann, Dieter Horstkotte, Tanja Kottmann, Klaus Peter Mellwig
INTRODUCTION: Low density lipoprotein (LDL-C) apheresis is a last treatment option for hypercholesterolemic patientsresistant to conservative lipid-lowering therapy. In a retrospective analysis of 8,533 heparin-induced extra-corporeal LDL precipitation apheresis treatments (HELP), we evaluated the efficacy of LDL reduction, the rate of adverse events, and the progression of atherosclerosis. METHODS: Between July 1992 and April 2009, we performed 8,533 HELP apheresis therapies in patients with familial hypercholesterolemia (FH)...
June 2012: Clinical Research in Cardiology Supplements
Volker Schettler, C L Neumann, M Hulpke-Wette, G C Hagenah, E G Schulz, E Wieland
BACKGROUND: One of the first investigations concerning extracorporeal treatment of hypercholesterolemia was performed in 1967 by plasma exchange in patients with homozygous or severe heterozygous familial hypercholesterolemia (FH). In the following decades, several specific lipid apheresis systems were developed to efficiently eliminate low-density lipoprotein (LDL) cholesterol and Lp(a) cholesterol in hypercholesterolemic patients. In the early 1980s, the main clinical indication has been homozygous FH including mainly children and pregnant women...
June 2012: Clinical Research in Cardiology Supplements
Alfonso Ramunni, Paola Brescia, Giuseppina De Fino, Giovanni Piscopo, Loreto Gesualdo
In microcirculation disorders, the therapeutic apheresis seems to have two different effects. The first, achieved after only a few sessions, is acute, consisting of drastic reduction of blood viscosity and obtained with the use of low-density lipoprotein (LDL) apheresis, rheopheresis, or fibrinogen apheresis. The second effect is long term, or chronic, and needs to be evaluated after a long course of treatment. The mechanisms underlying the chronic effect are still objects of debate and take into account the pleiotropic effects of apheresis...
June 2012: Clinical Research in Cardiology Supplements
Martin Canis, Franz Heigl, Markus Suckfuell
BACKGROUND: Fibrinogen/LDL apheresis has been proven to be effective in treatment of sudden sensorineural hearing loss (SSNH). This study is aimed to investigate if reduction of fibrinogen and serum LDL is also effective in patients with SSNH non-responding toward treatment with corticosteroids and plasmaexpanders. METHODS: Remission rates of 217 patients suffering from SSHL were investigated after treatment with apheresis. All patients were non-responders after other therapies such as high doses of steroids or plasmaexpanders...
June 2012: Clinical Research in Cardiology Supplements
K-P Mellwig, E Pulawski, D Horstkotte, F van Buuren
In the treatment of homozygous and therapy-resistant hypercholesterolemia, lipid apheresis enables not only low density lipoprotein (LDL) cholesterol to be lowered by approximately 60%, but also oxidative stress factors to be influenced and adhesion molecules reduced. This was investigated in a group of 12 patients using the heparin-induced extracorporeal LDL precipitation (H.E.L.P.) procedure.A significant lowering of LDL cholesterol and fibrinogen leads to an improvement in rheology and endothelial function, detectable and measurable within approximately 20 h by assessing minimum coronary resistance using positron emission tomography (PET) performed in 35 patients...
June 2012: Clinical Research in Cardiology Supplements
Nils Ewald, Hans-Ulrich Kloer
Hypertriglyceridemia is associated with a number of severe diseases such as acute pancreatitis and coronary artery disease. In severe hypertriglyceridemia (SHTG, triglycerides > 1,000 mg/dL), rapid lowering of plasma triglycerides (TG) has to be achieved. Treatment regimes include nutritional intervention, the use of antihyperlipidemic drugs, and therapeutic apheresis. Apheretic treatment is indicated in medical emergencies such as hypertriglyceridemic pancreatitis. Reviewing the current literature, plasmapheresis appears to be a safe and useful therapeutic tool in patients suffering from SHTG...
June 2012: Clinical Research in Cardiology Supplements
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