My husband has dangerously high cholesterol that so far has been unresponsive to drug treatment. His doctor is recommending LDL apheresis. What can you tell me about this treatment? Does it work? Is it safe?

Answers from Thomas Behrenbeck, M.D., Ph.D.

LDL apheresis is a procedure used to remove low-density lipoprotein (LDL), or "bad," cholesterol from the blood. LDL apheresis can be effective for people who:

  • Have heart disease and very high LDL cholesterol — higher than 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L)
  • Have very high LDL cholesterol that hasn't responded to diet changes or medication

LDL apheresis removes LDL cholesterol and related harmful cholesterol particles from the blood through a special filtering machine. During a treatment session — which may take three to four hours to complete — blood is removed from the body through a needle (usually placed in a vein in the arm) and sent to the filtering machine in a plastic tube. The machine removes the LDL cholesterol from the blood and then returns the "clean" blood through another vein.

LDL apheresis significantly lowers LDL cholesterol after just one treatment, but it's not a permanent solution. Because LDL apheresis doesn't correct the cause of the high cholesterol, LDL levels are likely to increase again after treatment. Typically, LDL apheresis must be repeated every one to two weeks. It's also essential to continue taking cholesterol-lowering medications and to follow a healthy, low-fat diet.

LDL apheresis is a safe procedure with a low risk of side effects. Though uncommon, possible complications may include:

  • Increased bleeding in the days following the procedure
  • Infection
  • Too much or too little fluid in the bloodstream
  • Air in the bloodstream (air embolism)
  • Low blood pressure during the procedure and for a few hours afterward

LDL apheresis isn't an option for anyone who has a blood disorder that makes it difficult for blood to coagulate, such as hemophilia or von Willebrand disease.

Because LDL apheresis is still a relatively new treatment, it's available only in a limited number of health care facilities.

Aug. 28, 2008