Lipoprotein Apheresis in Patients with Maximally Tolerated Lipid Lowering Therapy, Lp(a)-Hyperlipoproteinemia and Progressive Cardiovascular Disease: Prospective Observational Multicenter Study
Background—Lipoprotein(a)-hyperlipoproteinemia (Lp(a)-HLP) is a major risk factor for cardiovascular disease (CVD), which is not affected by treatment of other cardiovascular risk factors. This study sought to assess effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive CVD receiving maximally tolerated lipid lowering treatment.
Methods and Results—In a prospective observational multicenter study 170 patients were investigated, who commenced LA due to Lp(a)-HLP and progressive CVD. Patients were characterized regarding plasma lipid status, lipid lowering drug treatment, and variants at the LPA gene locus. Incidence rate of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. Mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA mean LDL-C and Lp(a) were 2.56±1.04 mmol*l-1 (99.0±40.1 mg*dl-1) and Lp(a) 3.74±1.63 µmol*l-1 (104.9±45.7 mg*dl-1), respectively. Mean annual rates for major adverse coronary events (MACE) declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA (p<0.0001). Event rates including all vascular beds declined from 0.61 to 0.16 (p<0.0001). Analysis of single years revealed increasing MACE-rates from 0.30 to 0.54 (p=0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 (p<0.0001) and to 0.05 from y+1 to y+2 (p=0.014).
Conclusions—In patients with Lp(a)-HLP, progressive CVD and maximally tolerated lipid lowering medication LA effectively lowered the incidence rate of cardiovascular events.
Clinical Trial Registration Information—www.germanctr.de; Identifier: DRKS00003119.
- Received March 7, 2013.
- Revision received September 4, 2013.
- Accepted September 10, 2013.