Low-density lipoprotein apheresis for the treatment of refractory hyperlipidemia

The advent of treatment with 3-hydroxy-3-methylglutaryl coenzyme A inhibito rs has meant that, with a combination of diet and drug therapy, adequate co ntrol of serum cholesterol concentrations can be achieved in most patients with hypercholesterolemia. However, some patients, primarily those with fam ilial hypercholesterolemia (FH), may require additional therapy to lower th eir cholesterol levels. In recent years, low-density lipoprotein (LDL) aphe resis has emerged as an effective method of treatment in these patients. Th e criteria for commencement of LDL apheresis are LDL cholesterol levels of 500 mg/dL or higher for homozygous FH patients, 300 mg/dL or higher for het erozygous FH patients in whom medical therapy has failed, and 200 mg/dL or higher for heterozygous FH patients with documented coronary disease and in whom medical therapy has failed. In addition to cholesterol lowering in pa tients with FH, other indications for LDL apheresis are emerging. These inc lude its use in the treatment of graft vascular disease in patients receivi ng cardiac transplants as well as in the treatment of certain glomeruloneph ritides. This review examines the role of LDL apheresis in the management o f lipid disorders and the evidence available to support its use in clinical practice.