Differences in the atherogenic risk of patients treated by lipoprotein apheresis according to their lipid pattern

Area of Science:

• Cardiology
• Vascular Medicine
• Lipidology

Background:

• High-risk patients on maximal lipid-lowering therapy often face persistent vascular complications.
• Lipoprotein apheresis is a therapeutic option that reduces LDL-cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] levels.
• Understanding the impact of apheresis based on lipid profiles is crucial for optimizing treatment.

Purpose of the Study:

• To evaluate the effectiveness of lipoprotein apheresis in preventing cardiovascular events across different patient lipid profiles.
• To compare the reduction rates of cardiovascular events before and after apheresis therapy.
• To emphasize the role of elevated Lp(a) as a risk factor.

Main Methods:

• Retrospective analysis of cardiovascular events in three patient groups based on baseline LDL-C and Lp(a) levels.
• Group 1: LDL-C ≥ 3.4 mmol/l and Lp(a) ≤ 600 mg/l (n=35).
• Group 2: LDL-C ≤ 3.4 mmol/l and Lp(a) ≥ 600 mg/l (n=37).
• Group 3: LDL-C ≥ 3.4 mmol/l and Lp(a) ≥ 600 mg/l (n=15).

Main Results:

• Cardiovascular events per patient decreased from 2.1 to 0.9 (Group 1), 3.4 to 0.5 (Group 2), and 1.8 to 0.5 (Group 3) under apheresis.
• Reduction rates of cardiovascular events were 54% (Group 1), 83% (Group 2), and 83.5% (Group 3) when comparing the two years before and after apheresis.
• Group 2, characterized by elevated Lp(a), had a longer time from first event to apheresis initiation (approx. 10 years vs. 2-6 years).

Conclusions:

• Lipoprotein apheresis significantly reduces cardiovascular events in high-risk patients.
• The reduction in cardiovascular events is notably higher in patients with elevated Lp(a) levels.
• Physicians should increase focus on elevated Lp(a) as a significant modifiable risk factor for vascular complications.