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Therapeutic Apheresis for Management of Lp(a) Hyperlipoproteinemia

Sergei N Pokrovsky1, Olga I Afanasieva2, Marat V Ezhov2

  • 1"National Medical Research Center of Cardiology" of Ministry of Health of the Russian Federation, Institute of Clinical Cardiology, 15A, 3d Cherepkovskaya street, Moscow, 121552, Russia. Dr.Pokrovsky@mail.ru.

Current Atherosclerosis Reports
|September 18, 2020
PubMed

Insights

High lipoprotein(a) (Lp(a)) levels are a cardiovascular risk. Lipoprotein apheresis (LA) effectively reduces Lp(a), decreasing cardiovascular event risk. This review covers optimal LA management for Lp(a) hyperlipoproteinemia.

Area of Science:

  • Cardiology
  • Lipidology
  • Vascular Medicine

Background:

  • Elevated lipoprotein(a) (Lp(a)) is a significant cardiovascular risk factor, particularly in atherosclerotic cardiovascular disease (ASCVD) patients.
  • Current lipid-lowering drugs are largely ineffective at reducing Lp(a) pathogenicity.
  • Lipoprotein apheresis (LA) is an effective, though not universally approved, method for removing atherogenic lipoproteins like Lp(a).

Purpose of the Study:

  • To review and present current information on the optimal management of Lp(a) hyperlipoproteinemia using lipoprotein apheresis (LA).
  • To discuss recent findings on the efficacy and application of LA in reducing cardiovascular risk associated with high Lp(a).

Main Methods:

  • Review of recent clinical studies and real-world data on various LA systems for Lp(a) reduction.
  • Analysis of the impact of Lp(a) elimination on inflammatory and thrombotic processes.
  • Evaluation of long-term outcomes and cardiovascular event rates in patients treated with LA.

Main Results:

  • LA effectively reduces Lp(a) levels by 60-80%, leading to decreased inflammation and plaque regression.
  • Sustained Lp(a) reduction via LA over 2-5 years is associated with a proportional decrease in cardiovascular event rates.
  • Specific Lp(a) apheresis targets Lp(a) exclusively, while non-specific LA is used for high-risk ASCVD patients. PCSK9 inhibitors show only modest effects on significantly elevated Lp(a).

Conclusions:

  • Lipoprotein apheresis is a crucial therapeutic option for managing Lp(a) hyperlipoproteinemia, especially in progressive ASCVD.
  • Sustained and significant reduction of Lp(a) levels is necessary to mitigate major adverse cardiovascular events.
  • Further research and broader approval of LA are warranted for optimal patient management.
Abstract

Keywords:
AtherosclerosisCardiovascular eventsLipoprotein apheresisLipoprotein(a)Specific Lp(a) apheresis

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