title: State of the art treatment of the most difficult low density lipoprotein (LDL) cholesterol problems: LDL apheresis.
abstract: The patient benefit from reduction of an excessively elevated low density lipoprotein (LDL) cholesterol is now well established, especially when there is proven coronary atherosclerosis. Dietary adherence can lower LDL cholesterol by a maximum of 10% to 15%. The addition of a cholesterol-lowering medication frequently can achieve a major LDL cholesterol reduction. However, a small group of patients with a very high LDL cholesterol respond poorly to diet and pharmaceutical treatments. These same patients have the highest incidence for very premature coronary atherosclerosis and associated cardiac events. A few medical centers, including the University of Kentucky, have established a new program to benefit these difficult high-risk patients. The technique is known as LDL apheresis, an effective process for removal of LDL cholesterol. The procedure is highly effective but very costly and third-party approval barriers are preventing access to this essential treatment for some very high-risk coronary atherosclerosis patients.
authors.affiliation: Division of Cardiovascular, Medicine of the Gill Heart Institute, Lexington, Ky.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Whayne
authors.forename: Judy C
authors.initials: JC
authors.lastname: Zielke
authors.forename: Larry G
authors.initials: LG
authors.lastname: Dickson
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
mesh_terms: D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000628:therapy*; D018579:Patient Selection; D010956:Plasmapheresis / Q000295:instrumentation / Q000379:methods*