Available online 27 April 2024

Elevated lipoprotein(a) is an established risk factor for cardiovascular disease

Lipoprotein apheresis is the only approved treatment to lower lipoprotein(a) relevantly

Event-free survival during lipoprotein apheresis was 72% higher

Elevated lipoprotein(a) (Lp(a)) is an established risk factor for cardiovascular disease (CVD). To date, the only approved treatment to lower Lp(a) is lipoprotein apheresis (LA). Previous studies have demonstrated that LA is effective in reducing cardiovascular (CV) risk in patients with elevated low-density lipoprotein cholesterol (LDL-C) and/or Lp(a). Here we report our long-term experience with LA and its effectiveness in reducing CVD events in patients with elevated Lp(a).

This retrospective open-label, single-center study included 25 individuals with Lp(a) elevation >60 mg/dL and LDL-C <2.59 mmol/L who had indication for LA. The primary endpoint of this study was the incidence of any CV event (determined by medical records) after initiation of LA.

Mean LA treatment duration was 7.1 years (min-max: 1-19 years). Median Lp(a) was reduced from 95.0 to 31.1 mg/dL after LA (-67.3%, p<0.0001). Mean LDL-C was reduced from 1.85 to 0.76 mmol/L after LA (-58.9%, p<0.0001). Prior LA, 81 CV events occurred in total (0.87 events/patient/year). During LA, 49 CV events occurred in total (0.24 events/patient/year; -0.63, p=0.001). Yearly major adverse cardiac event (MACE) rate was reduced from 0.34 to 0.006 (-0.33, p=0.0002). Similar results were obtained when considering only individuals with baseline LDL-C below 1.42 mmol/L.

In this observational study of a heterogeneous CV high-risk cohort with elevated Lp(a), LA reduced Lp(a) levels and was paralleled by a decrease in CV events and MACE. We recommend LA for patients with high Lp(a) who still have CV events despite optimal lipid-lowering medication and lifestyle changes.

Lipoprotein apheresis

lipoprotein(a)

cardiovascular disease

atherosclerosis

myocardial infarction

cardiovascular disease

Familial hypercholesterolemia

high-density lipoprotein cholesterol

heparin-mediated extracorporeal low-density lipoprotein [LDL] fibrinogen precipitation

intima media thickness

low-density lipoprotein cholesterol

major adverse cardiac event

randomized controlled trial

© 2024 National Lipid Association. Published by Elsevier Inc.