LDL-apheresis has evolved over the past 10-15 years from a cumbersome 'laboratory' procedure to a smooth and efficient progress. Adverse effects have been few and generally related to those side effects seen with all extracorporeal therapies, e.g. hypotension, dizziness, hemolysis. Acute LDL lowering is consistently 60-75% depending upon the number of plasma volumes processed. The procedure also efficiently removes lipoprotein (a) from the circulation. Elevated levels of Lp(a) have been shown to be of particular risk for patients with FH. Improvement in anginal symptoms and stress testing are frequently observed. Case reports and non-randomized studies have demonstrated regression of coronary artery disease when the total cholesterol was reduced to less than 100 mg/dL after the LDL-apheresis procedure. However, well-controlled randomized regression studies using LDL-apheresis have not been reported. LDL-apheresis has an important role in the therapy of patients with FH who do not respond or are intolerant to drug therapy. Clearer definition of patient populations and treatment end-points await further studies.
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