Apheresis
A single apheresis session cuts LDL and Lp(a) by about 65%, a review of apheresis for severe hypercholesterolaemia and elevated Lp(a) (Pathology 2019)
Original title: Apheresis for severe hypercholesterolaemia and elevated lipoprotein(a)
This review by Waldmann and Parhofer examines lipoprotein apheresis for patients with severe hypercholesterolaemia or elevated Lp(a) who do not reach treatment goals with lifestyle changes and standard drugs, or for whom no effective Lp(a)-lowering drug exists. A single apheresis session decreases LDL cholesterol and Lp(a) by approximately 65%, and weekly or biweekly apheresis maintains mean interval concentrations roughly 30% below baseline. Most apheresis systems, including HELP, DALI, dextran sulfate apheresis, lipid filtration and immunoadsorption, lower both LDL cholesterol and Lp(a), while Lipopac, a specific immunoapheresis technique, lowers only Lp(a). The authors note apheresis is well-tolerated but expensive and time-consuming, and that evidence for its clinical benefit currently comes from observational data, with adequate randomised controlled trials still lacking.
Original abstract
Low-density lipoprotein (LDL)-cholesterol (LDL-c) and lipoprotein(a) [Lp(a)] are independent cardiovascular risk factors. Reduction of LDL-c leads to reduction in cardiovascular events, regardless of the method of reducing LDL-c levels. Lifestyle modification and drugs are first line treatment options. However, many patients do not reach treatment goals, as defined in guidelines worldwide, through standard medication. So far, drugs are not efficient in lowering Lp(a) levels, or the reduction of plasma levels does not result in clinical benefit. In these two groups of patients lipoprotein apheresis is very efficient in decreasing LDL-c and Lp(a) levels. A single apheresis session can decrease LDL-c and Lp(a) by approximately 65%, and apheresis performed weekly or biweekly results in considerably decreased mean interval concentrations (approximately 30% reduction). Most apheresis systems (HELP, heparin induced extracorporeal LDL precipitation; DALI, direct adsorption of lipoproteins; lipoprotein apheresis with dextran sulfate; lipid filtration; immunoadsorption) decrease LDL-c and Lp(a). Lipopac is a specific form of immunapheresis and only decreases Lp(a). Lipoprotein apheresis is a well-tolerated treatment option but it is expensive and time consuming. The evidence for clinical benefit through regular apheresis comes from observational data. Adequate, randomised, controlled trials are lacking.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.