{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T05:47:59Z","timestamp":1792388879761,"version":"4.4.0"},"reference-count":73,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Familial hypercholesterolemia (FH) is a common inherited disorder characterized by markedly elevated low\u2010density lipoprotein cholesterol (LDL\u2010C) levels and an increased risk of premature cardiovascular disease. LDL apheresis is an extracorporeal procedure used to remove atherogenic lipoproteins from the circulation and is an established treatment option for selected patients with FH. This study aimed to systematically review and meta\u2010analyze the effectiveness of different LDL apheresis techniques in reducing LDL\u2010C and other lipid parameters in patients with FH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis was conducted on 9 March, 2025. PubMed\/MEDLINE, Scopus, Web of Science Core Collection, EMBASE, and Google Scholar were searched using relevant keywords and Medical Subject Headings (MeSH) terms, without restrictions on publication date or publication status. Data were extracted and managed using EndNote and Microsoft Excel, and statistical analyses were performed using Stata 2017. The methodological quality of the included studies was assessed using appropriate Joanna Briggs Institute (JBI) critical appraisal checklists. Subgroup and sensitivity analyses were performed to explore potential differences according to study characteristics. Random\u2010effects models were used to account for between\u2010study heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1060 records identified through database and reference\u2010list searches, 33 studies met the inclusion criteria. Germany contributed the largest number of included studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921). The pooled mean values following LDL apheresis were 163.40\u2009mg\/dL for total cholesterol (TC; 95% CI, 135.47\u2013191.34;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200998.47%), 122.99\u2009mg\/dL for LDL\u2010C (95% CI, 105.46\u2013140.51;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200996.71%), 19.41\u2009mg\/dL for lipoprotein(a) [Lp(a)] (95% CI, 9.84\u201328.98;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200996.83%), and 7.06\u2009mg\/dL for high\u2010density lipoprotein cholesterol (HDL\u2010C) (95% CI, 5.24\u20138.89;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200980.87%). The pooled reduction in triglycerides (TG) was 46.94\u2009mg\/dL (95% CI, 32.88\u201360.99;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200998.47%). Among the evaluated techniques, double\u2010filtration plasmapheresis (DFPP) showed the greatest reductions in TC, LDL\u2010C, and HDL\u2010C, with pooled reductions of 354.42, 281.82, and 15.75\u2009mg\/dL, respectively. No statistically significant differences among LDL apheresis techniques were observed for reductions in TG or Lp(a). Overall, the available evidence indicated reductions in these lipid parameters across the evaluated techniques, although substantial between\u2010study heterogeneity was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LDL apheresis was associated with substantial reductions in TC, LDL\u2010C, HDL\u2010C, TG, and Lp(a) in patients with FH. The available evidence suggests that different LDL apheresis techniques have broadly comparable effects on TG and Lp(a), whereas DFPP demonstrated greater reductions in TC, LDL\u2010C, and HDL\u2010C in the available comparative evidence. However, the safety evidence should be interpreted cautiously because adverse events were not quantitatively synthesized and reporting varied across studies. Therefore, the available evidence does not permit definitive conclusions regarding the comparative safety of LDL apheresis techniques. In clinical practice, selection of a specific technique should consider treatment characteristics, patient tolerance, technical requirements, resource availability, and cost considerations in addition to lipid\u2010lowering efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73292","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:47:38Z","timestamp":1791622058000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of LDL Apheresis Techniques for Reducing LDL\u2010C in Familial Hypercholesterolemia: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8018-5345","authenticated-orcid":false,"given":"Naser","family":"Derakhshani","sequence":"first","affiliation":[{"name":"Health Management and Economics Research Center, Health Management Research Institute Iran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Rezapour","sequence":"additional","affiliation":[{"name":"Health Management and Economics Research Center, Health Management Research Institute Iran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedeh Narges","family":"Pouyan","sequence":"additional","affiliation":[{"name":"Student Research Committee Tabriz University of Medical Sciences Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9610-3359","authenticated-orcid":false,"given":"Ramin","family":"Rezapour","sequence":"additional","affiliation":[{"name":"Tabriz Health Services Management Research Center Tabriz University of Medical Sciences Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1223-4528","authenticated-orcid":false,"given":"Jalal","family":"Arabloo","sequence":"additional","affiliation":[{"name":"Health Management and Economics Research Center, Health Management Research Institute Iran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Soleimanpour","sequence":"additional","affiliation":[{"name":"Department of Medical Library and Information Science, School of Health Management and Information Sciences Iran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3346-6846","authenticated-orcid":false,"given":"Somayeh","family":"Afshari","sequence":"additional","affiliation":[{"name":"Health Management and Economics Research Center, Health Management Research Institute Iran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ariamand","sequence":"additional","affiliation":[{"name":"Hospital Management Research Center, Health Management Research Institute Iran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"e_1_2_15_2_1","first-page":"1521","article-title":"The Metabolic and Molecular Bases of Inherited Disease","volume":"3","author":"Chen Y.","year":"2001","journal-title":"Glycogen storage diseases"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.93"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000297"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.15420\/ecr.2018:10:2"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.5551\/jat.14621"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2014.09.028"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03587-X"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016461"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI114531"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.009"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv289"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2013.19.2.139"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosissup.2011.06.001"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOL.0b013e3283402f53"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.4065\/76.10.1039"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-0968.2003.00070.x"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(98)00692-4"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.10035"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2006.02.030"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9150(02)00251-4"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2362.1998.00395.x"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1201\/b13411"},{"key":"e_1_2_15_24_1","doi-asserted-by":"crossref","unstructured":"J. P.HigginsandS.Green. Cochrane Handbook for Systematic Reviews of Interventions (2008).","DOI":"10.1002\/9780470712184"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-22-00430"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-22-00430"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1037\/1082-989X.11.2.193"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyn204"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2006.00336.x"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.4103\/apc.APC_56_19"},{"key":"e_1_2_15_31_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2362.1998.00395.x"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20006"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20135"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/976578"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-1101(2000)15:4<249::AID-JCA6>3.0.CO;2-B"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/039139880402700209"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosissup.2017.05.035"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9150(99)00398-6"},{"key":"e_1_2_15_39_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-0968.2001.00373.x"},{"key":"e_1_2_15_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21406"},{"key":"e_1_2_15_41_1","doi-asserted-by":"publisher","DOI":"10.1053\/meta.2001.23285"},{"key":"e_1_2_15_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2009.00747.x"},{"key":"e_1_2_15_43_1","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2018.0100"},{"key":"e_1_2_15_44_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/9709542"},{"key":"e_1_2_15_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.2003.07200.x"},{"key":"e_1_2_15_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-0968.2004.00105.x"},{"key":"e_1_2_15_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00227348"},{"key":"e_1_2_15_48_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-0968.2003.00070.x"},{"key":"e_1_2_15_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.1997.tb00013.x"},{"key":"e_1_2_15_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.08.007"},{"key":"e_1_2_15_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2009.00666.x"},{"key":"e_1_2_15_52_1","doi-asserted-by":"publisher","DOI":"10.1194\/jlr.M049726"},{"key":"e_1_2_15_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0026-0495(99)90223-8"},{"issue":"9","key":"e_1_2_15_54_1","first-page":"677","article-title":"One Year Experience With a Low Density Lipoprotein Apheresis System","volume":"4","author":"Durst R.","year":"2002","journal-title":"Israel Medical Association journal: IMAJ"},{"key":"e_1_2_15_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2015.10.015"},{"key":"e_1_2_15_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.06.049"},{"key":"e_1_2_15_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phclin.2012.03.002"},{"key":"e_1_2_15_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2008.00574.x"},{"key":"e_1_2_15_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-2275(20)32381-6"},{"key":"e_1_2_15_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12944-016-0353-x"},{"key":"e_1_2_15_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.htct.2021.01.009"},{"key":"e_1_2_15_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11936-006-0049-z"},{"key":"e_1_2_15_63_1","doi-asserted-by":"publisher","DOI":"10.1177\/039139880602900713"},{"key":"e_1_2_15_64_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199502233320802"},{"key":"e_1_2_15_65_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1594.2002.06837.x"},{"key":"e_1_2_15_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2007.01488.x"},{"key":"e_1_2_15_67_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1774-9987.2005.00236.x"},{"key":"e_1_2_15_68_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-0968.2003.00064.x"},{"key":"e_1_2_15_69_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-021-00911-w"},{"key":"e_1_2_15_70_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20036"},{"key":"e_1_2_15_71_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003294"},{"key":"e_1_2_15_72_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.10071"},{"key":"e_1_2_15_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1567-5688(09)71805-7"},{"key":"e_1_2_15_74_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2005.00306.x"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.73292","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.73292","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.73292","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T05:24:13Z","timestamp":1792387453000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.73292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":73,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/hsr2.73292"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.73292","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-06-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73292"}}