Role of apheresis in the management of familial hypercholesterolemia and elevated Lp(a) levels

Apheresis has an important role in the management of two common complex lipid disorders associated with a high risk of premature atherosclerotic disease, familial hypercholesterolemia (FH) and Lp(a) hyperlipidemia. More often than not, these high risk patients will first present to their primary care provider prior to consulting with a lipidologist. Because of this, FH and Lp(a)- hyperlipidemia require more emphasis globally in the public domain as well as in the medical community. Appropriate and aggressive treatment regimens include a combination of dietary and pharmacologic interventions with regularly scheduled apheresis sessions. LDL apheresis is a critical intervention for the successful treatment of homozygous FH patients, heterozygous FH patients intolerant to conventional therapy, patients with an elevated Lp(a) level or those patients with progressive cardiovascular disease despite maximum medical therapy. Newly released European guidelines emphasize the importance of screening and treatment of elevated Lp(a) levels in patients with intermediate or high cardiovascular risk.