Low-density lipoprotein apheresis: principles and indications.

Low-density lipoprotein (LDL) apheresis describes a group of apheresis techniques that selectively remove apolipoprotein B-containing lipoproteins producing an acute reduction in LDL-cholesterol (LDL-C). Six devices are available for the removal of LDL-C while sparing other important plasma components. The LDL-apheresis (LDL-A) is not routinely used for the treatment of hypercholesterolemia, which usually responds to medical management, but is used to treat familial hypercholesterolemia, an inherited metabolic abnormality resulting in premature death due to progressive coronary artery disease, and to treat patients who fail medical management. The mechanism of action of the available LDL-A devices, reactions that can occur with these treatments, and the role of this specialized apheresis technique in the treatment of hypercholesterolemia are described.