Clogged Arteries, Safety Net Holes: Treating an Underinsured Patient for Homozygous Familial Hypercholesterolemia With Plasmapheresis

Parth Patel; Iheoma Alinnor; Mary Ann Kirkconnell Hall; Lance T Hall; Stacey Watkins

doi:10.7759/cureus.70174

Clogged Arteries, Safety Net Holes: Treating an Underinsured Patient for Homozygous Familial Hypercholesterolemia With Plasmapheresis

Cureus. 2024 Sep 25;16(9):e70174. doi: 10.7759/cureus.70174. eCollection 2024 Sep.

Authors

Parth Patel^{1

2}, Iheoma Alinnor^{1

2}, Mary Ann Kirkconnell Hall¹, Lance T Hall^{3

4}, Stacey Watkins^{1

2}

Affiliations

¹ Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA.
² Hospital Medicine Service, Grady Memorial Hospital, Atlanta, USA.
³ Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA.
⁴ Nuclear Medicine Service, Grady Memorial Hospital, Atlanta, USA.

Abstract

This case report explores the difficulties with rapid lipid-lowering therapies in a resource-limited setting. We present a case of an individual with previously diagnosed homozygous familial hypercholesterolemia presenting with anginal chest pain concerning for non-ST elevation myocardial infarction (NSTEMI), with a low-density lipoprotein (LDL) of 984 mg/dL (reference range: 100-129 mg/dL) and a reversible perfusion defect on his nuclear medicine stress test. In addition to the standard treatment for NSTEMI, including cardiac catheterization, the patient was initiated on a proprotein convertase subtilisin/kexin type 9 inhibitor and underwent two rounds of plasmapheresis, which effectively and rapidly lowered his LDL levels.

Keywords: apheresis; homozygous familial hypercholesterolemia; low density lipoprotein cholesterol plasmapheresis; low density lipoprotein-cholesterol; therapeutic plasmapheresis.

Publication types

Case Reports