It has already been 10 years since the introduction of low-density lip
oprotein (LDL) apheresis technologies. They have been established as t
echnically and medically feasible for long-term treatment and economic
ally acceptable, and their long-term treatment effects have been deter
mined. Currently, there are efforts to develop more selective LDL remo
val systems. However, after 10 years of research, it is time to carefu
lly review this strategy. The approach may have become too specific in
light of the multiple macromolecules involved in the pathogenesis of
atherosclerosis. In this paper, the six currently available LDL aphere
sis systems (plasma exchange, double filtration plasmapheresis, thermo
filtration, LDL chemical adsorption (Kaneka system), LDL immunoadsorpt
ion, and the heparin-induced extracorporeal LDL precipitation [HELP] s
ystem) were reviewed and scored from various points of view such as ef
fectiveness, simplicity, safety, and cost performance. Finally, each s
ystem was assessed from the global point of view in relation to the pa
thogenesis of lipid-related diseases.