title: Prevention of cardiovascular complications in patients with Lp(a)-hyperlipoproteinemia and progressive cardiovascular disease by long-term lipoprotein apheresis according to German national guidelines.
abstract: Lipoprotein(a) (Lp(a)) is an independent cardiovascular risk factor playing a causal role for atherosclerotic cardiovascular disease (CVD). Lipoprotein apheresis (LA) is a safe well-tolerated outpatient treatment to lower LDL-C and Lp(a) by 60-70%, and is the ultimate escalating therapeutic option in patients with hyperlipoproteinemias (HLP) involving LDL particles. Major therapeutic effect of LA is preventing cardiovascular events. Lp(a)-HLP associated with progressive CVD has been approved as indication for regular LA in Germany since 2008. The Pro(a)LiFe-study investigated with a prospective multicenter design the long-term preventive effect of LA on incidence rates of cardiovascular events prospectively over a period of 5 years in 170 consecutive patients who commenced regular LA. During a median period of 4.7 years of the pre-LA period, Lp(a) associated progressive CVD became apparent. Apolipoprotein(a) (apo(a)) isoforms and polymorphisms at the apo(a) gene (LPA) were analyzed to assess hypothetical clinical correlations. 154 patients (90.6%) completed 5‑years follow-up. Significant decline of the mean annual major adverse cardiac event (MACE) rate was observed from 0.41 ± 0.45 two years prior to regular LA to 0.06 ± 0.11 during 5 years with regular LA (p < 0.0001). 95.3% of patients expressed at least one small apo(a) isoform. Calculation of isoform specific concentrations allowed to confirm the equivalence of 60 mg/dl or 120 nmol/l as Lp(a) thresholds of the German LA guideline. Results of 5 years prospective follow-up confirmed that LA has a lasting effect on prevention of cardiovascular events in patients with Lp(a)-HLP and afore progressive CVD.
authors.affiliation: Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany. afi@apheresis-research.org.|1st Department Internal Medicine, University of Mainz, Mainz, Germany. afi@apheresis-research.org.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Klingel
authors.affiliation: Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heibges
authors.affiliation: Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany.
authors.forename: Cordula
authors.initials: C
authors.lastname: Fassbender
mesh_terms: D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000592:standards*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006951:Hyperlipoproteinemias / Q000097:blood / Q000453:epidemiology / Q000235:genetics / Q000628:therapy*; D015994:Incidence; D017270:Lipoprotein(a) / Q000097:blood* / Q000235:genetics; D011110:Polymorphism, Genetic; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D017270:Lipoprotein(a)
keywords: Cardiovascular disease; Coronary artery disease; Lipoprotein (a); Lipoprotein apheresis; Prevention