A single apheresis session immediately clears over 60% of atherogenic apoB particles, remaining the mainstay treatment for FH and elevated Lp(a), a review (Curr Atheroscler Rep 2023)

Original title: Lipoprotein Apheresis: Current Recommendations for Treating Familial Hypercholesterolemia and Elevated Lipoprotein(a)

Curr Atheroscler Rep · 5 June 2023 · 6

Safarova MS, Moriarty PM

This review critically examines evidence for lipoprotein apheresis in treating familial hypercholesterolaemia (FH) and elevated Lp(a). A single apheresis procedure immediately reduces atherogenic apoB-containing lipoproteins by more than 60% on average, translating into substantial reductions in incident atherosclerotic cardiovascular events and prevention of accelerated vascular ageing; combining apheresis with LDL- and Lp(a)-targeting drug therapy further enhances efficacy. Apheresis also alters lipoprotein particle proteomics, reducing oxidised LDL, Lp(a), and proinflammatory apoE-bound particles, and improves blood rheology, endothelial function, microvascular flow and myocardial perfusion. The review concludes that lipoprotein apheresis is a safe and effective treatment for combined and isolated FH and elevated Lp(a), requiring coordinated care between patients and healthcare teams.

Original abstract

Purpose Of Review: Familial hypercholesterolemia (FH) and hyperlipoproteinemia(a) are relatively common disorders, posing a significant health burden due to increased risk of atherosclerotic cardiovascular disease (ASCVD). Development of electronic health record-based strategies with a linkage to the genetic test results has increased awareness, detection, and control of heritable lipid disorders. This review attempts to critically examine available data to provide a summary of the current evidence for lipoprotein apheresis in FH and elevated lipoprotein(a) (Lp(a)).

Review Findings: Availability and indications for lipoprotein apheresis vary across the globe. On average, greater than 60% of atherogenic apoB-containing lipoproteins are immediately reduced following a single procedure, translating in substantial reduction of incident ASCVD events, and preventing accelerated vascular aging. Simultaneous lipid-lowering therapy targeting low-density lipoprotein (LDL) and Lp(a) enhances the efficacy of lipoprotein apheresis. Lipoprotein apheresis alters the proteomics of the lipoprotein particles, including reduction in the concentration of the oxidized-LDL and Lp(a) particles, and proinflammatory apoE bound to HDL particles and remnant lipoproteins. Other effects attributed to lipoprotein apheresis include improvement in blood rheology, endothelial function, microvascular flow, myocardial perfusion, reduction in circulating inflammatory markers. Development of lipoprotein apheresis registries provides data on benefits, challenges, and barriers to inform pertinent healthcare policies. Lipoprotein apheresis is a safe and effective procedure for lowering cholesterol in patients with combined and isolated FH and elevated Lp(a). It reduces the burden of ASCVD and improves long-term prognosis. A team approach is required by the patient, medical staff, and healthcare provider to initiate and maintain a lipoprotein apheresis program.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.