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Updated: Jun 11, 2025
Isolation and Analysis of Plasma Lipoproteins by Ultracentrifugation
Published on: January 28, 2021
Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the
Insights
Lipoprotein apheresis (LA) offers significant cardiovascular benefits for high-risk patients with persistent hypercholesterolemia, particularly familial hypercholesterolemia. This underused therapy also improves endothelial function and may benefit kidney outcomes.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Metabolic Disorders
Background:
- Persistent hypercholesterolemia requires nonpharmacologic therapy in some high-risk patients.
- Lipoprotein apheresis (LA) is an underused adjunctive treatment for lowering LDL cholesterol and lipoprotein(a).
- LA is indicated for familial hypercholesterolemia in children and adults.
Purpose of the Study:
- To review the history, mechanisms, and outcomes of lipoprotein apheresis.
- To discuss current indications and treatment options for LA.
- To highlight the underutilization of LA despite evidence of cardiovascular benefits.
Main Methods:
- Review of observational studies and scientific literature on lipoprotein apheresis.
- Analysis of data on cardiovascular and renal outcomes associated with LA.
- Examination of LA's effects beyond lipid lowering, including inflammation and endothelial function.
Main Results:
- LA effectively lowers LDL cholesterol and lipoprotein(a).
- LA demonstrates beneficial effects on cardiovascular outcomes, endothelial function, and microvascular perfusion.
- Evidence suggests potential benefits for refractory focal segmental glomerulosclerosis, though data are limited.
- LA use in the US is below its FDA-approved indications.
Conclusions:
- Lipoprotein apheresis is a valuable therapy for specific patient populations, including those with familial hypercholesterolemia.
- Further research and increased utilization are warranted given the demonstrated cardiovascular benefits.
- LA's role in managing refractory focal segmental glomerulosclerosis requires additional investigation.
Abstract:
Despite the availability of multiple classes of lipoprotein-lowering medications, some high-risk patients have persistent hypercholesterolemia and may require nonpharmacologic therapy. Lipoprotein apheresis (LA) is a valuable but underused adjunctive therapeutic option for low-density lipoprotein cholesterol and lipoprotein(a) lowering, particularly in children and adults with familial hypercholesterolemia. In addition to lipid lowering, LA reduces serum levels of proinflammatory and prothrombotic factors, reduces blood viscosity, increases microvascular myocardial perfusion, and may provide beneficial effects on endothelial function. Multiple observational studies demonstrate strong evidence for improved cardiovascular outcomes with LA; however, use in the United States is limited to a fraction of its Food and Drug Administration-approved indications. In addition, there are limited data regarding LA benefit for refractory focal segmental glomerulosclerosis. In this scientific statement, we review the history of LA, mechanisms of action, cardiovascular and renal outcomes data, indications, and options for treatment.
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