LDL apheresis is a US Food and Drug Administration-approved medical therapy for patients who are not at LDL-C treatment goals or who have ongoing symptomatic disease. In patients who do not have an adequate response to maximal tolerated drug therapy after 6 months, LDL apheresis is indicated according to these guidelines:
- functional homozygote FH patients with LDL cholesterol levels >300 mg/dL or the
corresponding non-HDL cholesterol >330 mg/dL;
- functional heterozygote FH patients with LDL cholesterol >300 mg/dL or non-HDL
cholesterol >330 mg/dL and 0-1 additional risk factors;
- functional heterozygous FH patients with LDL cholesterol >200 mg/dL or non-HDL
cholesterols >230 mg/dL and high-risk characteristics such as more >2 risk factors
or an elevated lipoprotein(a) level >50 mg/dL using an isoform insensitive assay;
- functional heterozygotes with LDL cholesterol >160 mg/dL or non-HDL cholesterol
>190 mg/dL and very, very high-risk characteristics such as established CHD or
other cardiovascular disease and/or diabetes.
