Although statins are often the first line of treatment for individuals with high LDL cholesterol, familial hypercholesterolemia (FH), or high lipoprotein(a), also known as Lp(a), not all patients reach their LDL Safe Zone with statins.
In those cases, your healthcare provider may recommend lipoprotein apheresis. Lipoprotein apheresis is a nonsurgical therapy that removes high LDL cholesterol and Lp(a) from the blood. Lipoprotein apheresis is a two- to three-hour procedure where a person is connected to a special machine that filters their blood. The plasma portion of the blood, which contains cholesterol, is separated and run through the machine to remove the LDL and Lp(a) before the blood is returned to the body.
Who can do lipoprotein apheresis?
- People with FH, with or without cardiovascular disease
- People with homozygous FH (HoFH), with or without cardiovascular disease
- People with high Lp(a) who also have FH and cardiovascular disease
- Children with HoFH can begin lipoprotein apheresis as early as 3 years old.
Since the cholesterol levels in the blood go back up over time, this procedure is done every week to every other week. It is very safe and most people tolerate it well. However, it can mean that they might miss school or work. They might also have to drive a long distance because there are only 60 lipoprotein apheresis centers in the United States. A list of centers is below.
Ports and Fistulas
Lipoprotein apheresis can be done by accessing someone’s veins with special needles. However, people will often eventually need either a port or a fistula. A fistula is a large blood vessel created by surgically joining a vein and an artery. Fistulas are typically done in the forearm. Ports and fistulas helpthe apheresis team remove the blood from the blood vessels for treatment.
Before undergoing lipoprotein apheresis
Make sure you are not taking angiotensin-converting enzyme inhibitors (ACE inhibitors) to treat high blood pressure. The combination of lipoprotein apheresis and an ACE inhibitor can lead to severe plummeting of a person’s blood pressure.