Apheresis Indication Assessment
What is Apheresis Indication Assessment?
Apheresis indication assessment helps doctors determine if you qualify for a special treatment called lipoprotein apheresis. This treatment removes harmful cholesterol particles from your blood using a filtering machine. It works like dialysis but targets specific fats instead of kidney waste.
Lipoprotein apheresis is reserved for people with very high levels of Lipoprotein(a), or Lp(a), who have heart disease that keeps getting worse despite taking medications. Lp(a) is a sticky type of cholesterol particle that damages arteries and causes heart attacks and strokes. Unlike regular cholesterol, Lp(a) does not respond well to statins or lifestyle changes because it is mostly controlled by your genes.
The assessment involves measuring your Lp(a) level through a blood test. If your level is above 60 mg/dL or 150 nmol/L and you have progressive cardiovascular disease on maximum therapy, you may qualify for this treatment. Insurance typically covers apheresis only when strict criteria are met because the procedure requires ongoing sessions at specialized medical centers.
Symptoms
Apheresis indication assessment itself does not have symptoms. It is a medical evaluation based on your cardiovascular disease symptoms and blood test results. The conditions that lead to needing this assessment include:
- Recurrent heart attacks despite taking medications
- Progressive angina or chest pain that worsens over time
- New blockages in heart arteries after stenting or bypass surgery
- Early heart disease before age 55 in men or age 65 in women
- Stroke or mini-stroke at a young age
- Peripheral artery disease causing leg pain when walking
- Family history of premature heart disease or very high Lp(a)
Many people with high Lp(a) have no symptoms for years until they experience a sudden heart attack or stroke. This is why blood testing is the only way to know your level.
Concerned about Apheresis Indication Assessment? Check your levels.
Screen for 1,200+ health conditions
Causes and risk factors
The need for apheresis indication assessment is caused by having both very high Lp(a) levels and progressive cardiovascular disease. Lp(a) levels are determined almost entirely by your genetics. You inherit your Lp(a) level from your parents, and it stays fairly constant throughout your life. Diet, exercise, and most cholesterol medications do not lower Lp(a). About 1 in 5 people have elevated Lp(a), and about 1 in 20 have very high levels that may require apheresis.
Risk factors that lead to needing this assessment include having a family history of premature heart disease, multiple heart events despite statin therapy, and ancestry from certain populations with higher Lp(a) prevalence. African Americans, South Asians, and people of European descent have higher rates of elevated Lp(a). If you have other cardiovascular risk factors like smoking, diabetes, or high blood pressure along with high Lp(a), your risk of progressive disease increases significantly.
How it's diagnosed
Diagnosis involves measuring Lipoprotein(a) through a blood test and evaluating your cardiovascular disease history. Your doctor will review your medical records to see if you have had recurrent heart attacks, new blockages after treatment, or worsening symptoms despite taking maximum doses of statins and other medications. They will also check if your Lp(a) level meets the threshold of 60 mg/dL or 150 nmol/L needed to qualify for apheresis.
Rite Aid offers Lipoprotein(a) testing as an add-on to our comprehensive blood panel. You can get tested at Quest Diagnostics locations nationwide to learn your Lp(a) level. If your result is very high and you have cardiovascular disease, share the results with your cardiologist to discuss whether apheresis might be appropriate. Additional tests like coronary angiography or cardiac stress tests may be needed to document progressive disease before insurance approves the treatment.
Treatment options
- Lipoprotein apheresis sessions every 1 to 2 weeks at specialized centers to remove Lp(a) from blood
- Continue taking statins, aspirin, and other heart medications as prescribed
- Adopt a heart-healthy diet low in saturated fat and refined carbohydrates
- Engage in regular physical activity to improve cardiovascular fitness
- Stop smoking and limit alcohol to reduce additional cardiovascular risk
- Manage blood pressure and blood sugar if you have hypertension or diabetes
- Consider newer medications like PCSK9 inhibitors that may modestly lower Lp(a)
- Discuss emerging therapies like antisense oligonucleotides with your cardiologist
- Screen family members for high Lp(a) since it runs in families
- Work closely with a cardiologist experienced in managing high Lp(a) patients
Need testing for Apheresis Indication Assessment? Add it to your panel.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
You typically need an Lp(a) level above 60 mg/dL or 150 nmol/L to qualify for lipoprotein apheresis. However, the level alone is not enough. You must also have progressive cardiovascular disease that continues despite taking maximum doses of cholesterol medications. Insurance companies review your medical history and current symptoms before approving this treatment.
Most patients receive lipoprotein apheresis every 1 to 2 weeks. Each session takes 2 to 4 hours at a specialized medical center. The treatment filters your blood to remove Lp(a) and other cholesterol particles. Because your liver continues making Lp(a), regular sessions are needed to keep levels low and prevent further cardiovascular events.
Insurance may cover apheresis if you meet strict medical criteria. You need documented high Lp(a), progressive cardiovascular disease, and proof that maximum medication therapy has failed to control your condition. Your doctor must submit detailed medical records and test results for approval. Coverage varies by insurance plan, so check with your provider about specific requirements.
No, diet and exercise do not significantly lower Lp(a) levels. Lp(a) is controlled almost entirely by your genes. Unlike LDL cholesterol, it does not respond to lifestyle changes. However, eating a heart-healthy diet and staying active still help reduce your overall cardiovascular risk by improving other factors like blood pressure and inflammation.
Currently available medications do not effectively lower Lp(a). Statins may even slightly increase Lp(a) in some people. PCSK9 inhibitors can lower Lp(a) by about 20 to 30 percent, which may help some patients. Several experimental drugs specifically targeting Lp(a) are in clinical trials and show promising results, but they are not yet approved for general use.
Yes, Lp(a) is inherited and runs in families. If you have high Lp(a), your children, siblings, and parents have a 50 percent chance of also having elevated levels. Early testing allows family members to work with their doctors on prevention strategies. Knowing your Lp(a) level helps guide decisions about cholesterol medications and cardiovascular screening.
Apheresis is generally safe but may cause side effects like low blood pressure, nausea, or lightheadedness during treatment. Rare complications include bleeding, infection at the IV site, or allergic reactions to materials used in the filtering process. The benefits of preventing heart attacks and strokes usually outweigh these risks for patients with very high Lp(a) and progressive disease.
Some patients notice improvement in chest pain within weeks to months of starting regular apheresis. Studies show that apheresis reduces the frequency of cardiovascular events like heart attacks and the need for procedures like angioplasty. However, individual response varies. Your cardiologist will monitor your symptoms and may repeat imaging tests to track plaque progression over time.
No, you should continue taking your prescribed medications even while receiving apheresis. Statins lower LDL cholesterol and reduce inflammation, which are important for cardiovascular health beyond just Lp(a). Apheresis works best when combined with maximum medical therapy. Always discuss medication changes with your cardiologist before stopping or adjusting doses.
Apheresis is a treatment, not a cure. Your body continues making Lp(a) at the same rate determined by your genes. Each apheresis session temporarily removes Lp(a) from your blood, but levels rise again between treatments. This is why regular ongoing sessions are needed. Future therapies targeting Lp(a) production may offer more lasting solutions as research advances.