Specific Lipoprotein(a) apheresis attenuates progression of carotid intima-media thickness in coronary heart disease patients with high lipoprotein(a) levels.
BACKGROUND
To date, there have been no studies evaluating the effect of isolated lipoprotein(a) (Lp(a)) lowering therapy on carotid atherosclerosis progression.


METHODS
We enrolled 30 patients who had coronary heart disease (CHD) verified by angiography, Lp(a) level ≥50 mg/dL, and low density lipoprotein cholesterol (LDL-C) level ≤2.6 mmol/L (100 mg/dL) on chronic statin therapy. Subjects were allocated in a 1:1 ratio to receive apheresis treatment on a weekly basis with immunoadsorption columns ("Lp(a) Lipopak"(®), POCARD Ltd., Russia) added to atorvastatin, or atorvastatin monotherapy. The primary efficacy end-point was the change from baseline in the mean intima-media thickness (IMT) of the common carotid arteries.


RESULTS
After one month run-in period with stable atorvastatin dose, LDL-C level was 2.3 ± 0.3 mmol/L and Lp(a) - 105 ± 37 mg/dL. As a result of acute effect of specific Lp(a) apheresis procedures, Lp(a) level decreased by an average of 73 ± 12% to a mean of 29 ± 16 mg/dL, and mean LDL-C decreased by 17 ± 3% to a mean of 1.8 ± 0.2 mmol/L. In the apheresis group, changes in carotid IMT at 9 and 18 months from baseline were -0.03 ± 0.09 mm (p = 0.05) and -0.07 ± 0.15 mm (p = 0.01), respectively. In the atorvastatin group no significant changes in lipid and lipoprotein parameters as well as in carotid IMT were received over 18-month period. Two years after study termination carotid IMT increased by an average of 0.02 ± 0.08 mm in apheresis group and by 0.06 ± 0.10 mm in the control group (p = 0.033).


CONCLUSIONS
Isolated extracorporeal Lp(a) elimination over an 18 months period produced regression of carotid intima-media thickness in stable CHD patients with high Lp(a) levels. This effect was maintained for two years after the end of study.


BACKGROUND
Clinicaltrials.gov (NCT02133807).
Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia. Electronic address: Marat_Ezhov@mail.ru.
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Ezhov
Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia.
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Safarova
Laboratory of Atherosclerosis, Institute of Experimental Cardiology, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia.
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Afanasieva
Ultrasound Laboratory, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia.
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Pogorelova
Ultrasound Laboratory, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia.
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Tripoten
Laboratory of Atherosclerosis, Institute of Experimental Cardiology, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia.
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Adamova
Center of Extracorporeal Therapies, MEDSI Clinic, 3A, Georgian Lane, Moscow 123056, Russia.
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Konovalov
Ultrasound Laboratory, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia.
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Balakhonova
Laboratory of Atherosclerosis, Institute of Experimental Cardiology, Federal State Institution "Russian Cardiology Research and Production Center" of Ministry of Health of the Russian Federation, 15A, 3d Cherepkovskaya Street, Moscow 121552, Russia.
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Pokrovsky
D000328:Adult; D000069059:Atorvastatin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000379:methods*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006951:Hyperlipoproteinemias / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D007163:Immunosorbent Techniques; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012426:Russia; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D015854:Up-Regulation
D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017270:Lipoprotein(a); D000069059:Atorvastatin
Atherosclerosis; Carotid intima-media thickness; Immunoadsorption; Lipoprotein(a); Lp(a) apheresis; Regression