Low-density lipoprotein (LDL) apheresis, also referred to as lipoprotein apheresis or lipid apheresis, is a procedure that involves extracorporeal treatment of plasma to remove apoprotein (apo) B-containing lipoproteins followed by reinfusion of the processed blood. This specialized adjunctive procedure is reserved for patients who have severe refractory hypercholesterolemia after treatment with maximally tolerated LDL-lowering medications in combination with lifestyle changes, most often in the context of the genetic disorder familial hypercholesterolemia (FH). It is estimated that 2–4 % of patients with FH meet the criteria for initiating LDL apheresis, which means that about 1 in 12,500 to 1 in 50,000 individuals may be candidates for LDL apheresis. The approximately 3-h procedure acutely lowers the plasma LDL cholesterol concentration by up to 85 %, as well as lowering the concentrations of Lp(a) and remnant lipoproteins. The procedure has several documented cardiovascular benefits, including a 72 % reduction in cardiovascular events compared to standard medical therapy in a long-term open label trial.
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