Abstract 15449: Modulation of Coronary Plaque Composition by Specific Lipoprotein(a) Apheresis

Abstract

Background. No imaging studies have shown that targeted lipoprotein(a) [Lp(a)] reduction has a favorable effect on coronary disease progression. Following the hypothesis that Lp(a) excess has a detrimental role in atherogenesis, we evaluated the efficacy of specific Lp(a) apheresis on changes in coronary plaque composition in patients with CHD on the top of optimal medical treatment. Methods. A total of 30 subjects (mean age 53.2±7.5 years, 67% male) with established CHD, Lp(a) level >50 mg/dL, and LDL-C level ≤100 mg/dL on chronic statin treatment were prospectively evaluated for 18 months. Patients were allocated to weekly specific Lp(a) immuadsorption procedures (n=15, “Lp(a) Lipopak”® columns, POCARD Ltd., Russia) on the atorvastatin background, or atorvastatin only (n=15). Blinded virtual histology intravascular ultrasonographic (VH IVUS) imaging was performed at baseline and follow-up. Results. The final change in Lp(a) level in the apheresis group was −31.7±5.7 mg/dL, as compared with 4.8±2.8 mg/dL in the atorvastatin monotherapy group (P = 0.0001); change in LDL-C level in the apheresis group was −3.1±3.5 mg/dL, as compared with −3.5±3.5 mg/dL in the atorvastatin group (P = 0.96). Median total atheroma volume was reduced by -4.60 mm3 (95% confidence interval, -13.19 to -1.81, P=0.001) with apheresis and by -1.45 mm3 (-6.18 to 3.54, P=0.99) with atorvastatin. Modulation of plaque components at baseline and after 18 months is shown in the Table. Lp(a) apheresis reduced plaque volume mainly due to decrease in fibrous and lipid components. There was a significant correlation between percent change in Lp(a) level and the absolute change in lipid content (R=0.42, P <0.05). Conclusion. Specific Lp(a) apheresis is an efficacious method for significant reduction of elevated Lp(a) levels. Using Lp(a) as a therapeutic target results in further stabilization of coronary atherosclerosis in CHD patients with high Lp(a) levels and reached LDL-C goals.