title: Dramatic fate of a young coronary heart disease patient rescued with specific lipoprotein(a) apheresis.
abstract: Lipoprotein(a) [Lp(a)] is acknowledged to be an independent atherothrombotic risk factor. Although genetic studies have highlighted the causal relationship between coronary disease and Lp(a), it is uncertain which strategies maximize the therapeutic benefit of patients with high Lp(a) levels. We report the challenging case of a young coronary heart disease (CHD) patient who underwent 10 percutaneous coronary interventions due to repeated acute coronary syndromes (2006-2009) despite an optimally controlled, traditional risk-factor profile. For the first time, we performed specific Lp(a) immunoadsorption in the presence of very low levels of low-density lipoprotein cholesterol (LDL-C) while the patient was on a high-dose statin regimen. There have been no previous reports of patients with high Lp(a) levels who achieved LDL-C goals when treated with an isolated Lp(a)-lowering method. Despite the very high risk of cardiovascular death, targeting Lp(a) resulted in dramatic improvement of the patient's clinical condition. Thus, we suggest that specific Lp(a) apheresis should be considered an effective new treatment strategy for patients with progressive CHD who have reached LDL-C goals but harbor elevated Lp(a) levels.
authors.affiliation: Atherosclerosis Department, Russian Cardiology Research and Production Center, Moscow, Russia.
authors.forename: Maya S
authors.initials: MS
authors.lastname: Safarova
authors.affiliation: Atherosclerosis Department, Russian Cardiology Research and Production Center, Moscow, Russia.
authors.forename: Marat V
authors.initials: MV
authors.lastname: Ezhov
authors.affiliation: Atherosclerosis Department, Russian Cardiology Research and Production Center, Moscow, Russia.
authors.forename: Olga I
authors.initials: OI
authors.lastname: Afanasieva
authors.affiliation: Center of Extracorporeal Therapies, MEDSI Clinic, Moscow, Russia.
authors.forename: Gennady A
authors.initials: GA
authors.lastname: Konovalov
authors.affiliation: Atherosclerosis Department, Russian Cardiology Research and Production Center, Moscow, Russia.
authors.forename: Sergei N
authors.initials: SN
authors.lastname: Pokrovsky
mesh_terms: D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000628:therapy*; D018450:Disease Progression; D006801:Humans; D017270:Lipoprotein(a) / Q000737:chemistry*; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D017270:Lipoprotein(a)
keywords: coronary heart disease; lipoprotein(a); prevention; residual risk; specific Lp(a) immunoadsorption