Skill Checkup: A 43-Year-Old Man With a History of Smoking and Current Pressure in the Middle of the Chest and Dyspnea

Romesh Khardori, MD, PhD, FACP


January 12, 2022

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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