Incorporation of low-density lipoprotein apheresis into the treatment program of patients with severe hypercholesterolemia.

Treatment to low-density lipoprotein (LDL) cholesterol targets has become a focus in the management of patients with coronary heart disease (CHD). Many patients with familial hypercholesterolemia (FH) are unable to reach targets because of drug intolerance or extremely high baseline LDL cholesterol levels. Consequently, LDL apheresis has become a useful modality for the treatment of patients with severe hypercholesterolemia. Commonly used LDL apheresis systems utilize immunoadsorption columns, dextran sulfate cellulose columns, or heparin precipitation. A new and simpler treatment modality is emerging which uses whole blood compatible columns. All systems require systemic anticoagulation, extracorporeal processing of blood, and venous vascular access. Acute LDL lowering is 70% to 80% and time-averaged LDL lowering is 40% to 50%. Lipoprotein(a) is also substantially lowered. Clinical efficacy has been shown in several studies. Mechanisms for clinical improvement in addition to regression of atherosclerotic plaque have been suggested by recent research.