Is Lipoprotein (a)—Apheresis Useful?

Abstract

Numerous epidemiological investigations have shown the importance of cholesterol, and in particular low density lipoprotein (LDL), and of the lipoproteins in the development of coronary sclerosis. A continuing relationship between cholesterol levels and coronary morbidity has been established. The LDL concentration in the blood is, in particular, to be made responsible for the development of arteriosclerosis and especially of coronary heart disease (CHD). Lipoprotein (a) [Lp(a)], as a risk factor for premature cardiovascular and cerebrovascular diseases, can be lowered by LDL-apheresis. Especially in isolated high levels of Lp(a) with CHD or polygenic hypercholesterolemia with elevated Lp(a) levels, LDL-apheresis can be indicated and can be useful to improve endothelium regulation and induce changes in coronary tone by an increase in endothelial derived relaxing factor. Lipoprotein (a) can be dramatically lowered by LDL-apheresis, but clinical improvement especially by low LDL is not still not clarified. Studies with weekly apheresis with statins versus drug therapy alone are necessary. To clarify the controversial discussions of whether lowering Lp(a) may be unnecessary or necessary to arrest progression of CHD, more clinical and randomized studies are needed. Lipoprotein (a) can be also lowered by current LDL-apheresis methods.

LDL-apheresis: indications and clinical experience in a tertiary cardiac centre

“…Four principal LDL‐apheresis systems are currently available: specific immunoadsorption (IMA), dextran sulphate adsorption (DSA), heparin‐induced extracorporeal LDL precipitation (HELP) and direct absorption of lipoprotein (DALI). All techniques are equal regarding effectiveness in reducing TC, LDL‐C and triglycerides both acutely and in the long‐term, clinical outcome and safety (10,13,22). Liposorber D is a newer system based in DSA technology, where, similarly to DALI, atherogenic lipoproteins are selectively removed from whole blood without plasma separation being required (8,13).…”

“…Moreover, patient 1 who had very high Lp(a) levels with relatively low baseline TC levels, showed improvement in symptomatology, no new acute coronary events, an improved exercise capacity during exercise testimony and no further progression in Myoview perfusion scanning. At present, drug therapy is insufficient to significantly reduce Lp(a) (22), and LDL‐apheresis remains the only option. We calculated a slightly higher acute HDL‐C reduction compared to results from other centres using liposorber D (15,17), probably caused by the hemodilution effect.…”

Management of Familial Hypercholesterolemias in adult patients: Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia

“…67 LDL apheresis is the only treatment shown to consistently reduce lipoprotein (a) levels by more than 50%. 68 Although LDL apheresis is effective for retarding the development of atherosclerosis, and is often the only viable option for certain patients such as those with homozygous FH, the procedure is time consuming (more than 3 hours every 1 to 2 weeks) and expensive. 62,69 LDL apheresis referrals Physicians should refer candidates for LDL apheresis to qualified sites.…”

Variation of Lp(a) Plasma Concentrations in Health and Disease~!2009-11-03~!2010-02-06~!2010-09-08~!

“…In detail, dependent on the treated plasma or blood volume concentrations of Lp(a) and LDL are lowered 50 % -74 % and >60 % at each therapy and even other hemorheological parameters (e.g. fibrinogen, viscosity) are positively influenced [294][295][296][297][298][299][300][301][302][303][304][305][306][307][308][309][310] (Table 1).…”