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Clinical Research in Cardiology Supplements

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Open Access 01-04-2019 | PCSK9 Inhibitor

Lipoprotein apheresis is an optimal therapeutic option to reduce increased Lp(a) levels

Authors: V. J. J. Schettler, C. L. Neumann, C. Peter, T. Zimmermann, U. Julius, B. Hohenstein, E. Roeseler, F. Heigl, P. Grützmacher, H. Blume, R. Klingel, A Vogt, Scientific Board of GLAR for the German Apheresis Working Group

Published in: Clinical Research in Cardiology Supplements | Special Issue 1/2019

Abstract

Background

Lipoprotein(a) (Lp(a)) is a genetic risk factor for cardiovascular disease (CVD) and is associated with the induction and sustaining of atherosclerotic cardiovascular diseases (ASCVD). Since 2008 Lp(a) along with progressive CVD has been approved as an indication for regular lipoprotein apheresis (LA) in Germany. The German Lipoprotein Apheresis Registry (GLAR) has been initiated to provide statistical evidence for the assessment of extracorporeal procedures to treat dyslipidemia for both LDL-cholesterol (LDL-C) and Lp(a). The GLAR now allows prospective investigations over a 5-year period about annual incidence rates of cardiovascular events. Here Lp(a) patients (LDL-C < 100 mg/dl; Lp(a) > 60 mg/dl or >120 nmol/l) showed the same reduction of major coronary (83%) and non-coronary events (63%) as had been formerly shown in the Pro(a)LiFe study. However, Lp(a) is not only an apolipoprotein(a) (apo(a)) and LDL-C containing particle, which is covalently bound to a LDL-C core by a disulphide bridge. The composition of this particle, inter alia containing oxidized phospholipids, gives pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing atherosclerotic processes mainly in the arterial wall. However, recent investigations have shown that a reduction of inflammatory settings without LDL-C or Lp(a) reduction may reduce ASCVD events. Lipoprotein apheresis (LA) could not only reduce LDL-C and Lp(a) in parallel, but also different inflammatory and coagulation parameters. In summary lipoprotein apheresis is not only anti-atherosclerotic, but also anti-inflammatory and anti-thrombotic and therefore an ideal treatment option with respect to the shown reduction of major adverse coronary events (MACE) and major adverse non-coronary events (MANCE) by reducing Lp(a) levels.

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Title: Lipoprotein apheresis is an optimal therapeutic option to reduce increased Lp(a) levels
Authors: V. J. J. Schettler
C. L. Neumann
C. Peter
T. Zimmermann
U. Julius
B. Hohenstein
E. Roeseler
F. Heigl
P. Grützmacher
H. Blume
R. Klingel
A Vogt
Scientific Board of GLAR for the German Apheresis Working Group
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Keyword: PCSK9 Inhibitor
Published in: Clinical Research in Cardiology Supplements / Issue Special Issue 1/2019
Print ISSN: 1861-0706
Electronic ISSN: 1861-0714
DOI: https://doi.org/10.1007/s11789-019-00094-4

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Abstract

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