Quality of life in patients treated with lipoprotein apheresis.

OBJECTIVES: Elevated levels of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] are known risk factors for atherosclerosis and cardiovascular events. Although lipoprotein apheresis (LA) yields optimal outcomes for patients suffering from progressive cardiovascular disease (CVD; coronary, peripheral, and cerebrovascular arterial disease) in the presence of hyperlipoproteinemia (LDL-C > 100 mg/dL or Lp(a) > 60 mg/dL), LA primarily serves as a "last-resort therapy". Extant findings show that the incidence of new cardiovascular events can be reduced by regular LA. However, it remains unclear whether improvements to the quality of life (QOL) improvement produced by the positive impact on the course of cardiovascular disease outweighs the therapy's time consuming and invasive character. We surveyed 36 patients (32 men and 4 women; age 53 ± 13 years [mean + standard deviation]) undergoing regular LA therapy to assess the effects of apheresis on QOL. METHODS: QOL was evaluated in 29 patients on regular lipoprotein apheresis treatment using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), the Beck Depression Inventory (BDI), and a newly developed questionnaire for assessing QOL in patients undergoing LA. RESULTS: Patients treated with LA showed lower QOL scores regarding mental aspects and equal scores regarding physical aspects compared to the general population, analogue to the results of patients on hemodialysis (SF-36). Analysis of BDI scores showed apheresis patients did not meet criteria for depression diagnosis, although their depression scores were higher than the general population. Compared to the pre-apheresis period, patients described an improvement of their physical and mental fitness, less angina pectoris and no treatment related pain were reported (apheresis questionnaire). CONCLUSIONS: Apheresis treatment appears to reduce the subjective physical complaints of patients. The partly impaired mental health in patients undergoing apheresis may be attributed to the underlying severe cardiovascular disease. The procedure itself is generally tolerated without major complaints, suggesting the benefits of apheresis exceed any negative effects on patient QOL.

Mental symptoms and quality of life in lipoprotein apheresis patients in comparison to hemodialysis patients, platelet donors and normal population.

BACKGROUND: Despite the fact that extracorporeal methods such as lipoprotein apheresis (LA) and hemodialysis (HD) are highly effective in improving the physical status of patients, these treatment options may possibly harm the psychological status and the health related quality of life (HRQL). METHODS: The occurrences of anxiety, depression and the HRQL of 111 study participants treated with LA (n = 41), HD (n = 41) or undergoing plateletpheresis (PD) (n = 29) were compared to the normal population (NP), using standardized questionnaires (anxiety and depression: Hospital Anxiety and Depression Scale (HADS), heart-focused anxiety: Cardiac Anxiety Questionnaire (CAQ) and HRQL: Short-Form Health Survey (SF-12)). Additionally, the subjective mental and physical stress of study participants was evaluated. RESULTS: LA females had a significantly elevated HADS-A score compared to PD and NP. Additionally, there was a trend toward higher HADS-A scores in the LA group compared to the HD group in females. In HD males HADS-A and -D scores increased compared to PD and NP. The CAQ revealed a significant increase in the CAQ-Fear scale in LA compared to HD and PD participants. The CAQ-Avoidance score showed significantly increased scores in LA and HD patients compared to PD and NP. In the CAQ-Attention scale the LA patients also showed significantly increased scores compared to PD and NP. The increased psychological symptoms were associated with significantly lower levels of objective and subjective HRQL in LA and HD patients compared to PD and NP. CONCLUSIONS: LA and HD patients had similarly increased presence of psychological symptoms with concurrent decreased quality of life compared to PD and the normal population, which may affect the outcome of the LA patients. Therefore, early psychosomatic screening and probable psychosomatic treatment should be performed.

[Possibilities of correction of mental disorders and dyslipoproteinemia in patients with neurocirculatory asthenia]. / Vozmozhnosti korrektsii narushenii psikhiki i dislipoproteinemii u bol'nykh neirotsirkuliatornoi distoniei.

A total of 230 patients with neurocirculatory dystonia (NCD) were investigated. Different mental disorders associated with the atherogenic nature of dyslipoproteinemia were revealed in the majority of patients using the clinical scale and MMPI test. Psychotropic agents used for a period of 2-4 mos improved the mental status of these patients, increased exercise tolerance, and decreased blood levels of free fatty acids (FFA). A course of exercise training (graded walking) for 4-6 mos. helped to enhance exercise tolerance, to lower the blood levels of cholesterol, triglycerides, FFA, the total fraction of low- and very low-density lipoproteins, to reduce manifestations of hypochondriasis, depression, and neurasthenia . The results obtained can be used for developing programs of NCD patients' rehabilitation.

Emotional implications of primary familial hyperlipoproteinemia in childhood and adolescence.

To determine whether 43 patients and their 23 unaffected siblings were at increased risk for psychologic upset, 28 families of children being treated for primary familial hyperlipoproteinemia were studied. Nine fathers but no mothers had died of the disease. The families were interviewed for psychiatric assessment, and the parent(s) scored a questionnaire concerning eight behavioral factors. Male patients had significantly higher scores for impulsive hyperactive behavior than their male siblings. Fatherless female patients had the highest scores for perfectionism and the lowest scores for conduct problems and impulsive hyperactive behavior. Fatherless children scored lower for impulsive hyperactive behavior than children with fathers; fatherless male children were more anxious than fatherless female children. There were more significant differences in scores for children whose father was still alive vs those whose father had died than in scores for affected children vs unaffected siblings. Thus, the emotional impact of the premature death of an affected parent appears greater than that of having the disease. Therefore, one should be alert for changes in behavior in children with primary familial hyperlipoproteinemia when a parent dies of the disease and as the patients approach the age at which the parent died.