[LDL apheresis for the treatment of familial hypercholesterolemia. A systematic review]

Low-density lipoprotein (LDL) apheresis is indicated in patients with familial hypercholesterolemia who are resistant to drug therapy. The study evaluates whether the various apheresis techniques available result in relevant improvement of clinical endpoints (cardiovascular morbidity and mortality, quality of life).

A systematic literature review in standard databases (Medline, EMBASE, CRD York, Cochrane, and others) was conducted. Extraction of core data, assessment of study quality and evidence rating according to the GRADE method were undertaken in an internal peer-review process.

Evidence from the ten studies included weakly indicates an improvement in angina symptoms and reduced mortality. However, due to limited study quality, no reliable answers are possible concerning the question whether LDL apheresis results in reduced cardiovascular morbidity/mortality or improved quality of life.

The available evidence indicates a possible net benefit of LDL apheresis. However, since the quality of the evidence is very low, treatment should be strictly restricted to patients with severe familial hypercholesterolemia who are resistant to standard care.