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.