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LDL-apheresis in two patients with extremely elevated lipoprotein (a) levels
R Bambauer1, R Schiel, H E Keller
1University of Saarland, Homburg/Saar, Germany.
Insights
LDL-apheresis effectively reduced extremely high lipoprotein (a) [Lp(a)] levels in patients with familial hypercholesterolemia. This treatment also decreased cardiovascular events and improved patient performance.
Area of Science:
- Cardiology
- Biochemistry
- Internal Medicine
Background:
- Elevated lipoprotein (a) [Lp(a)] and hyperlipidemia are associated with premature atherosclerosis.
- Familial hypercholesterolemia presents challenges in lipid management.
- Extreme Lp(a) levels can be resistant to conventional therapies.
Purpose of the Study:
- To evaluate the efficacy of LDL-apheresis in managing extremely high Lp(a) concentrations.
- To assess the impact of LDL-apheresis on lipid profiles and cardiovascular events.
Main Methods:
- Two male patients with heterozygous familial hypercholesterolemia and extreme Lp(a) levels were treated with LDL-apheresis.
- Treatment involved a liposorber system and an immunoadsorption system over 15-55 months.
- Lipid levels, Lp(a), and fibrinogen were monitored.
Main Results:
- LDL-apheresis reduced Lp(a) by 50%, total cholesterol by 27%, LDL-cholesterol by 42%, and triglycerides by 43%.
- Fibrinogen levels decreased by 16%.
- Patients experienced no further myocardial infarctions or cardiac complaints post-treatment, reporting improved performance.
Conclusions:
- LDL-apheresis demonstrates significant effectiveness in reducing extremely high Lp(a) levels.
- The treatment appears to prevent cardiovascular events in patients with resistant hyperlipidemia and high Lp(a).
- LDL-apheresis offers a promising therapeutic option for selected patients with severe lipid disorders.
Abstract:
Hyperlipidemia and elevated lipoprotein (a) [Lp(a)] levels have been linked to the development and progression of premature atherosclerosis. Two male caucasian patients (36 and 42 years old) with heterozygous familial hypercholesterolemia and extremely elevated Lp(a) concentrations, resistant to diet regimen and lipid lowering drugs, were treated with LDL-apheresis for 55 months (liposorber system, Kaneka, Japan) and 15 months (immunoadsorption system, special Lp(a) columns, Lipopak, Pocard, Russia). Lp(a) dropped on average by 50%, total cholesterol by 27%, LDL-cholesterol by 42%, triglycerides by 43% and the fibrinogen concentration by 16%. Prior to treatment, both patients had suffered three myocardial infarctions. Four and six coronary angiographies with two and four percutaneous transluminal angioplasties (PTCA) were necessary. Since the treatment with LDL-apheresis neither myocardial infarctions nor cardiac complaints have been observed, and both patients have reported better performance. Available data suggest that LDL-apheresis may be effective in the treatment of patients with extremely high Lp(a) concentration.