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Twelve years' experience confirms that plasma exchange beneficially influences the course of homozygous familial hypercholesterolemia. Pilot studies with low density lipoprotein (LDL) apheresis using a dextran sulphate affinity column suggest that this procedure has advantages over plasma exchange, which it may eventually replace. Combination therapy with lovastatin and LDL apheresis is currently being assessed as a means of inducing regression of coronary lesions. Preliminary results of a pilot study in four patients with heterozygous familial hypercholesterolemia are encouraging.
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