For more severe cases (homozygous FH or severe heterozygous FH with inadequate response to cholesterol-lowering therapies) in which patients cannot achieve LDL-C targets, lipoprotein apheresis may be an option. Selected patients with FH and ASCVD who meet the current US Food and Drug Administration criteria of LDL‐C > 100 mg/dL (2.6 mmol/L) after maximally tolerable therapy are candidates for the Dextran Sulfate Low‐Density Lipoprotein Adsorption system (LA‐15; Kaneka, Osaka, Japan), the only apheresis system available in the United States, for second-line therapy (as either monotherapy or in conjunction with other methods). Moderate exercise and diet modifications are suggested for all patients with FH.
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