Diana Joy Albertsen ate right and exercised. Between that and working, volunteering, and managing her and husband David’s busy Arvada household of three biological and five foster kids, it was no surprise that her five-foot-one frame carried a lean 100 pounds.

Yet despite taking cholesterol-lowering drugs, her “bad” cholesterol numbers – for low-density lipoprotein (LDL) cholesterol – were generally stuck at 1.5 times or more than the typical upper bound for intervention, which is 100 mg/dL. By her mid-forties, Albertsen had survived three heart attacks, and five stents were keeping her coronary arteries open.

There would be 14 more years of angina and other health scares until Albertsen, now 61, found an effective treatment. Called lipid apheresis, it involves pumping the patient’s blood through a machine that removes dangerous fat particles. Think of it as a sort of oil change for the bloodstream. She does a roughly three-hour session once every two weeks at the Cardiometabolic and Advanced Lipid Disorders Clinic at UCHealth University of Colorado Hospital on the Anschutz Medical Campus, the only center in the region offering lipid apheresis.

A genetic predisposition for sky-high bad cholesterol

Albertsen is far from alone in the fight against cholesterol. For most, dietary and lifestyle changes, plus drugs such as statins, can keep the problem in check. But she’s among the roughly one in 250 people whose familial hypercholesterolemia (FH) makes controlling cholesterol much harder. FH is hereditary, and only about one in ten people with FH even know they have it. That’s scary, because those with untreated FH have a lifetime stroke and heart attack risk about 20 times higher than that of the general population.

What’s more, Albertsen is among the roughly 20% of the population with a genetic predisposition for unhealthy levels of lipoprotein(a), or Lp(a), an LDL cholesterol particle that’s bonded with a protein. Lp(a) doesn’t respond to diet and exercise, it’s not detected by standard blood panels, and it can lead to atherosclerosis, thrombosis, and, aortic valve calcification. Lipid apheresis is the only U.S Food and Drug Administration-approved treatment for reducing Lp(a).

“Patients have done diet and exercise for years and years and years. They’re taking maximum doses of statins or they can’t tolerate statins, and they’re still having cardiac events,” said Melissa Nasser, a clinical nurse who oversees lipid apheresis sessions at UCHealth.

Albertsen is among those who can’t tolerate statins. Like many with FH and/or high Lp(a) levels, it took years to arrive at a diagnosis. That’s despite her father having died of a heart attack at 62 and two brothers and a sister also having had heart attacks. It took more years and many heart scares for lipid apheresis to come into play.

“Their cardiologists throw up their hands, saying, ‘We’ve tried everything,’” Nasser said. “A lot of them don’t know that this exists, or that it’s an option.”

Lipid apheresis is gaining awareness

That’s finally changing, said Dr. David Saxon, the University of Colorado School of Medicine endocrinologist who directs UCHealth’s Lipid Apheresis Program as well as CU’s Cardiometabolic & Advanced Lipid Clinic. A recent American Heart Association statement on lipid apheresis and the numbers it reported have been catalysts, he says.

Lipid apheresis reduces average LDL cholesterol by about 40% and average Lp(a) levels by about 25%, lowering the risk of cardiovascular events such as heart attacks, strokes, or a peripheral arterial disease (PAD) blockage by 50% to 85%. Among the other benefits include reduced angina, better exercise tolerance, better blood flow to the heart, and better leg-wound recovery among those with PAD. The American Heart Association statement’s authors say 11,000 to 15,000 patients nationally could benefit from lipid apheresis – more than 25 times the 400 or so U.S. patients who currently access it, “underscoring the barriers to access and likely lack of awareness of its benefits and indications.”

Lipid apheresis takes out the bad, leaves the good cholesterol

During a recent biweekly lipid apheresis session, Albertsen reclined in a UCHealth Dialysis Center clinic room (lipid apheresis and hemodialysis machines are different, but the setup and general idea of ridding the blood of unwanted elements are similar). She squeezed a green grip ball to help keep the blood flowing from a vein in her left forearm and through a thin crimson-filled line. An occasional beeping and red light led Nasser to subtly adjust the machine’s flow.

“Having this treatment is 100 times better than going through life not knowing and experiencing symptoms,” Albertsen said.

Her blood will pass through the Kaneka machine more than twice during the roughly two-and-a-half hours she’s hooked up to it. The machine first separates the plasma from the incoming blood (plasma makes up about 55% of blood volume), then uses negatively charged microscopic beads to trap LDL cholesterol, lipoproteins and triglycerides. High-density cholesterol – “good” cholesterol – is much less affected and mostly remains in the plasma. IV fluid is mixed in to make up for water loss during filtration, and another crimson-filled line leads back to a vein in Albertsen’s right forearm.

Boosting energy for patients with familial high cholesterol

By the time the session’s over, Albertsen will have about 80% less LDL cholesterol and 70% less Lp(a) in her bloodstream. (The averages cited above are lower, because the fat particles build up during the two weeks between lipid apheresis sessions.) Also, liquid apheresis turns the consistency of Albertsen’s blood from something like tomato soup to more like tomato juice, Nasser says. That lower viscosity means less work for the heart and better odds against clotting.

Albertsen says liquid apheresis treatments have boosted her overall energy.

“I did a lot, but I was always tired,” she said. Now, she added, “I can live my life and play with my grandkids.”

Her husband, David, agreed.

“She has more energy. She’s mentally a lot more positive about things – and her health also,” he said.

Albertsen has even come to appreciate the time she spends with Nasser and UCHealth colleagues during her lipid apheresis sessions.

“They understand what you’re going through. They understand your fears. When I walked in here, I didn’t feel alone with it,” she said. “They become

your family.”