Lipoprotein apheresis: Current overview and future outlook in clinical practice

Abstract

Lipoprotein apheresis (LA) remains a critical therapeutic approach for patients with severe lipid disorders, particularly those who fail to achieve target LDL-C or lipoprotein(a) [Lp(a)] levels despite advances in pharmacological therapies. While new therapies, such as PCSK9 inhibitors, antisense oligonucleotides, and siRNA-based treatments, have expanded the options for lipid management, LA continues to serve as an essential last resort for high-risk individuals. Patients with homozygous familial hypercholesterolemia (HoFH) or severe hypercholesterolemia (sHCH) often require LA to mitigate extreme cardiovascular risks, including premature myocardial infarction and aortic valve stenosis. Furthermore, LA is the only available therapy capable of effectively reducing elevated Lp(a) levels, a known independent risk factor for cardiovascular events. The recent introduction of anti-inflammatory treatments for atherosclerosis, such as low-dose colchicine, highlights the multifaceted nature of cardiovascular disease and underscores the importance of multimodal treatment strategies. LA, with its dual ability to remove LDL-C and Lp(a) particles as well as inflammation-inducing agents, may offer unique advantages in addressing these complex pathologies. In light of these developments, LA retains its relevance as a safe and effective intervention for individuals who do not respond adequately to other lipid-lowering therapies. By integrating LA into broader treatment frameworks, including acute-phase cardiovascular event management, its potential to improve long-term outcomes warrants further clinical investigation. To date, the pivotal role of LA in modern cardiovascular care must be reaffirmed, emphasizing its continued significance as a fundamental component of comprehensive lipid-lowering strategies for high-risk patient populations.