Elective treatment for patients affected with familial hyper- cholesterolemia, in addition to drug therapy, is the removal of cholesterol by apheresis. This can be obtained by selective, semiselective or non- selective techniques. Comparisons among different methods are very difficult, owing to the various, specific for each type of apheretic procedure, factors, which can greatly influence the treatment efficacy. Nevertheless, with the aid of some mathematical formulas, as recently proposed by Jovin et al., it is possible to quantify correctly the total removal of different lipoprotein fractions, thus gaining a true index of treatment efficacy. According to our data, heparin induced extracorporeal LDL precipitation (HELP system), dextran sulfate adsorption (i.e., two selective techniques) and traditional plasma- exchange (i.e., a non-selective technique) have been resulted to be similar with respect to the efficacy, namely to the removal of C-LDL. However, the recovery of C-HDL has been highly greater when using selective methods than when treating patients with plasma-exchange. Since the HDL fraction has been demonstrated to have a protective role on coronary atherosclerosis, to date selective techniques represent the gold standard for LDL apheresis. Nevertheless, plasma-exchange has to be considered for particular cases, on account of both the technical feasibility and the good efficacy.