Lipoprotein apheresis is an optimal therapeutic option to reduce increased Lp(a) levels

Abstract

Background Lipoprotein(a) (Lp(a)) is a genetic risk factor for cardiovascular disease (CVD) and is associated with the induction and sustaining of atherosclerotic cardiovascular diseases (ASCVD). Since 2008 Lp(a) along with progressive CVD has been approved as an indication for regular lipoprotein apheresis (LA) in Germany. The German Lipoprotein Apheresis Registry (GLAR) has been initiated to provide statistical evidence for the assessment of extracorporeal procedures to treat dyslipidemia for both LDL-cholesterol (LDL-C) and Lp(a). The GLAR now allows prospective investigations over a 5-year period about annual incidence rates of cardiovascular events. Here Lp(a) patients (LDL-C < 100 mg/dl; Lp(a) > 60 mg/dl or >120 nmol/l) showed the same reduction of major coronary (83%) and non-coronary events (63%) as had been formerly shown in the Pro(a)LiFe study. However, Lp(a) is not only an apolipoprotein(a) (apo(a)) and LDL-C containing particle, which is covalently bound to a LDL-C core by a disulphide bridge. The composition of this particle, inter alia containing oxidized phospholipids, gives pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing atherosclerotic processes mainly in the arterial wall. However, recent investigations have shown that a reduction of inflammatory settings without LDL-C or Lp(a) reduction may reduce ASCVD events. Lipoprotein apheresis (LA) could not only reduce LDL-C and Lp(a) in parallel, but also different inflammatory and coagulation parameters. In summary lipoprotein apheresis is not only anti-atherosclerotic, but also anti-inflammatory and anti-thrombotic and therefore an ideal treatment option with respect to the shown reduction of major adverse coronary events (MACE) and major adverse non-coronary events (MANCE) by reducing Lp(a) levels.Keywords Lipoprotein apheresis · Lipoprotein (a) · Cardiovascular disease · Coronary artery disease · Major coronary events · Major non-coronary events · Inflammation · Prevention This article is part of the special issue "Lp(a) -Update 2018"

Lp(a): der akzeptierte unabhängige Risikofaktor

“…Erst seit 2009 konnte in einer longitudinalen Kohortenstudie, später in der Pro(a)Li-Fe-Studie, einer prospektiven multizentrischen Beobachtungsstudie, dieser günstige und beeindruckende Ein uss auf die kardiovaskuläre Morbidität und Mortalität bei Apherese patienten mit isoliert erhöhter Lp(a)-Konzentration (bedeutet: Lp(a) > 60 mg/dl (> 120 nmol/l); LDL-Cholesterin < 100 mg/dl (< 2,56 mmol/l) gezeigt werden [27][28][29]: eine Reduktion von kardiovaskulären Ereignissen um 78 % bereits nach 2 Jahren LA-Therapie. Diese beachtliche Reduktionsrate von kardiovaskulären Ereignissen kann auch aus Datenauswertungen von Lp(a)-Patienten unter chronischer LA aus dem Deutschen Lipoproteinapherese-Register bestätigt werden (DLAR) [30].…”

“…Unter diesem Aspekt sind allerdings noch weitere Studien bei Patienten unter chronischer LA unter Berücksichtigung der neuesten Erkenntnisse aus den bekannten In ammationsmodellen notwendig. Nach wie vor stellen die in Deutschland zugelassenen LA-Verfahren zurzeit die optimale Therapieform in der Behandlung von Patienten mit erhöhten Lp(a)-Konzentrationen und progredienten kardiovaskulären A ektionen dar [30].…”

Bernd Hohenstein appointed as Editor representing the European Group—International Society for Apheresis

“…In 2012, he received an endowed Professorship for Extracorporeal Techniques, lipoprotein apheresis, and metabolic disorders from the Faculty of Medicine Carl Gustav Carus at the Technische Universitaet Dresden. He became the Division Head of the Therapeutic Apheresis Center in Dresden as one of the largest apheresis units in Germany 13–18 …”

Lipoproteinapherese

“…trationen und progredienten kardiovaskulären Affektionen sowie für Patienten mit erhöhten LDL-C-Konzentration trotz maximal lipidsenkender Therapie mit sehr hohem kardiovaskulärem Risiko dar[31]. Bei akuten Ereignissen wie z.…”