The evidence-base for the efficacy of lipoprotein apheresis in combating cardiovascular disease

Objective: To review the evidence supporting the use of lipoprotein apheresis to treat severe forms of dyslipidaemia that predispose to cardiovascular disease and are refractory to conventional therapy. Methods: Review of relevant publications based on personal knowledge and a search of the literature from the past 10 years using PubMed. Results: There is good evidence that drastic lowering of LDL by lipoprotein apheresis increases longevity in homozygous familial hypercholesterolaemia (FH) and decreases cardiovascular morbidity in FH heterozygotes refractory to or intolerant of statins. Lipoprotein apheresis may also decrease cardiovascular events in patients with raised levels of Lp(a) but further data are needed. Conclusions: Lipoprotein apheresis currently provides a therapeutic life-line for a small number of very high risk patients. It remains to be seen what effect the recent emergence of several novel and powerful lipid-lowering drugs will have on its future role in that respect. (C) 2012 Elsevier Ireland Ltd. All rights reserved.