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Isolation and Analysis of Plasma Lipoproteins by Ultracentrifugation
Published on: January 28, 2021
Long-term lipoprotein apheresis reduces cardiovascular events in high-risk patients with isolated lipoprotein(a)
Friederike Schumann1, Ursula Kassner1, Dominik Spira1
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Endocrinology, Division of Lipid Disorders, Augustenburger Platz 1, 13353 Berlin, Germany (Drs Schumann, Kassner, Spira, Bobbert, Steinhagen-Thiessen and Hollstein).
Insights
Lipoprotein apheresis (LA) significantly lowers lipoprotein(a) (Lp(a)) and reduces cardiovascular events in high-risk patients. This long-term study shows LA is effective in preventing major adverse cardiac events (MACE) for individuals with elevated Lp(a).
Area of Science:
- Cardiology
- Lipidology
- Preventive Medicine
Background:
- Elevated lipoprotein(a) (Lp(a)) is a significant risk factor for cardiovascular disease (CVD).
- Lipoprotein apheresis (LA) is the sole approved treatment for lowering Lp(a).
- Previous research indicates LA's efficacy in mitigating cardiovascular risk in patients with high LDL-C and/or Lp(a).
Purpose of the Study:
- To evaluate the long-term effectiveness of LA in reducing cardiovascular events.
- To assess the impact of LA on Lp(a) and LDL-C levels in patients with elevated Lp(a).
- To analyze the reduction in major adverse cardiac events (MACE) during LA treatment.
Main Methods:
- A retrospective, open-label, single-center study involving 25 individuals with Lp(a) >60 mg/dL and LDL-C < 2.59 mmol/L requiring LA.
- The primary endpoint was the incidence of any cardiovascular event post-LA initiation.
- Data collected included Lp(a), LDL-C levels, and cardiovascular event occurrences.
Main Results:
- Mean treatment duration with LA was 7.1 years.
- LA significantly reduced median Lp(a) by -67.3% (95.0 to 31.1 mg/dL) and mean LDL-C by -58.9% (1.85 to 0.76 mmol/L).
- The incidence of CV events decreased from 0.87 to 0.24 events/patient/year, and the yearly MACE rate fell from 0.34 to 0.006.
Conclusions:
- Lipoprotein apheresis (LA) effectively lowers Lp(a) and is associated with a significant reduction in cardiovascular events and MACE.
- LA is recommended for high-risk patients with elevated Lp(a) experiencing CV events despite optimal medical and lifestyle interventions.
- The study highlights LA's role in managing cardiovascular risk in a heterogeneous, high-risk cohort.
Background:
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).
Methods:
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.
Results:
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 to 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.
Conclusion:
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.
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