This AHA scientific statement reviews the mechanisms, clinical outcomes, and indications for lipoprotein apheresis, emphasizing its role as an important adjunctive therapy for severe, refractory hypercholesterolemia.
Despite the availability of multiple classes of lipoprotein-lowering medications, some high-risk patients have persistent hypercholesterolemia and may require nonpharmacologic therapy. Lipoprotein apheresis (LA) is a valuable but underused adjunctive therapeutic option for low-density lipoprotein cholesterol and lipoprotein(a) lowering, particularly in children and adults with familial hypercholesterolemia. In addition to lipid lowering, LA reduces serum levels of proinflammatory and prothrombotic factors, reduces blood viscosity, increases microvascular myocardial perfusion, and may provide beneficial effects on endothelial function. Multiple observational studies demonstrate strong evidence for improved cardiovascular outcomes with LA; however, use in the United States is limited to a fraction of its Food and Drug Administration-approved indications. In addition, there are limited data regarding LA benefit for refractory focal segmental glomerulosclerosis. In this scientific statement, we review the history of LA, mechanisms of action, cardiovascular and renal outcomes data, indications, and options for treatment.
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Gianos et al. (2024) conducted a review in Familial hypercholesterolemia. Lipoprotein apheresis was evaluated. Lipoprotein apheresis is a valuable but underused adjunctive therapy for lowering LDL and lipoprotein(a) in high-risk patients, with observational evidence supporting improved cardiovascular outcomes.
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