Long-term lipoprotein apheresis promising in reducing CV events in high-risk patients with isolated Lp (a) elevation: Study

In the study of 25 individuals with isolated lipoprotein (a) elevation, the findings suggest lipoprotein apheresis was associated with reductions in median Lp(a), cardiovascular (CV) events, and mean LDL-C among patients with an indication for the treatment.

"We recommend lipoprotein apheresis for patients with high Lp(a) who still have CV events despite optimal lipid-lowering medication and lifestyle changes," the researchers wrote.

Lipoprotein(a), or Lp(a), is a cholesterol-rich particle linked to an increased risk of heart attacks, strokes, and other cardiovascular events. Despite its well-established role in cardiovascular health, effective treatment options for individuals with elevated Lp(a) levels have remained limited until now.

Friederike Schumann, Charité – Universitätsmedizin Berlin, Germany, and colleagues report long-term experience with LA and its effectiveness in reducing CVD events in patients with elevated Lp(a).

For this purpose, the researchers conducted a retrospective open-label, single-center study of 25 individuals with Lp(a) elevation >60 mg/dL and LDL-C < 2.59 mmol/L who indicated lipoprotein apheresis. The study's primary endpoint was the incidence of any CV event (determined by medical records) after LA initiation.

The following were the key findings of the study:

· Mean LA treatment duration was 7.1 years. Median Lp(a) was reduced from 95.0 to 31.1 mg/dL after LA (-67.3 %).

· Mean LDL-C was reduced from 1.85 to 0.76 mmol/L after LA (-58.9 %).

· Before LA, 81 CV events occurred (0.87 events/patient/year). During LA, 49 CV events occurred in total (0.24 events/patient/year; -0.63).

· Yearly major adverse cardiac event (MACE) rate was reduced from 0.34 to 0.006.

· Similar results were obtained when considering only individuals with baseline LDL-C below 1.42 mmol/L.

The long-term observation indicated that patients receiving lipoprotein apheresis for elevated Lp(a) exhibited a lower rate of CV events after the therapy initiation than their pre-therapy status.

The researchers note that as an observational study, it does not establish a causal relationship between lipoprotein apheresis and the reduction in cardiovascular event rates. Rather, these results suggest a correlation that warrants further investigation.

"Even as new therapies emerge, lipoprotein apheresis continues to serve as a valuable alternative treatment for patients who fail to achieve lipid goals despite undergoing maximum lipid-lowering therapy or those who experience intolerance to lipid-lowering drugs," they concluded.

Reference:

Schumann F, Kassner U, Spira D, et al. Long-term lipoprotein apheresis reduces cardiovascular events in high-risk patients with isolated lipoprotein(a) elevation. Journal of Clinical Lipidology. Published online April 27, 2024. doi:10.1016/j.jacl.2024.04.134.