Role of Lipoprotein Apheresis in Cardiovascular Disease Risk Reduction

Abstract

Background and Aim: Elevated low-density lipoprotein cholesterol and/or lipoprotein(a) are established risk factors for cardiovascular disease (CVD). Management of hypercholesterolemia consists of drug therapies, including statins and proprotein convertase subtilisin/kexin type 9 inhibitors. In patients with familial hypercholesterolemia (FH), lipoprotein apheresis (LA) is utilized to control lipid levels. However, LA is not currently a standard therapy for non-FH. This review summarizes the literature regarding LA therapy in CVD prevention. Methods: PubMed/MEDLINE databases were searched using the keywords “LA” and “CVD”. Citations were individually reviewed for relevance. Results: The efficacy of LA was clearly demonstrated, largely based on evidence from observational studies. In patients who are unresponsive to traditional lipid-lowering medications, LA effectively reduced serum lipoprotein levels and adverse cardiovascular events. Conclusion: It was concluded that LA is a safe and effective technique that could be considered in the management of hypercholesterolemia and future risk. Randomized control trials would further support a role for LA as a therapeutic option.

Lipoprotein(a) Lowering—From Lipoprotein Apheresis to Antisense Oligonucleotide Approach

“…In the US, the Food and Drug Administration approved LA for HoFH patients with LDL-C > 500 mg/dL (12.92 mmol/L) (beginning in childhood), for HeFH with LDL-C >300 mg/dL (7.75 mmol/L) and no sign of CVD, or with known CVD and LDL-C > 200 mg/dL (5.17 mmol/L) [ 119 ]. In Japan, LA is approved for patients with CVD and total cholesterolemia > 250 mg/dL (6.46 mmol/L) [ 120 ]. As elsewhere reviewed in detail [ 121 ], available LA techniques are categorized as selective (immune adsorption, dextran sulfate adsorption, heparin precipitation, cascade filtration and polyacrylamide adsorption) or non-selective (plasma exchange; Table 3 ).…”

Atherogenic Lipoproteins for the Statin Residual Cardiovascular Disease Risk

“…A single apheresis session can acutely decrease Lp(a) by approximately 60–75%, and apheresis performed weekly or biweekly results in considerably decreased mean interval concentrations (approximately 25–40% reduction) [ 68 ]. There are no RCTs showing a reduction in CVD by treating high Lp(a) levels with lipoprotein apheresis.…”

Management of Familial Hypercholesterolemia with Special Emphasis on Evinacumab

“…Among others, it is recommended for the patients in question with LDL-C levels > 300 mg/dL, or for those with additional high cardiovascular risk with accompanying LDL-C levels > 200 mg/dL, or patients with diabetes/CVD and LDL-C levels > 160 mg/dL [ 45 ]. Raina et al [ 46 ] conducted a study in which they evaluated the role of LA as a next-line treatment option for lowering LDL-C levels. LA therapy as a subsequent treatment option appears to have significant efficacy in reducing LDL-C and Lp(a) levels and prevents the development and worsening of CVD in FH patients whose lipid levels are inadequately lowered with available pharmacotherapy [ 46 ].…”

“…Raina et al [ 46 ] conducted a study in which they evaluated the role of LA as a next-line treatment option for lowering LDL-C levels. LA therapy as a subsequent treatment option appears to have significant efficacy in reducing LDL-C and Lp(a) levels and prevents the development and worsening of CVD in FH patients whose lipid levels are inadequately lowered with available pharmacotherapy [ 46 ].…”