LDL apheresis is an effective method of lowering low-density lipoprotein (LDL) concentration in patients with familial hypercholesterolemia (FH) who are either refractory to treatment or intolerant of medical therapy. We searched the medical literature through July 2004 using PubMed and Medline and the search terms "LDL apheresis", "cardiovascular", and "disease" to identify apheresis techniques and to evaluate their effects on cardiovascular pathophysiology and clinical outcomes. We conclude that LDL apheresis reduces cardiovascular events in hypercholesterolemic patients and may be an effective treatment for other vascular diseases including cholesterol embolic disease, focal segmental glomerular sclerosis, sudden hearing loss, and age-related macular degeneration.