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Current Atherosclerosis Reports

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01-11-2020 | PCSK9 Inhibitor | Nonstatin Drugs (M. Vrablik, Section Editor)

Therapeutic Apheresis for Management of Lp(a) Hyperlipoproteinemia

Authors: Sergei N. Pokrovsky, Olga I. Afanasieva, Marat V. Ezhov

Published in: Current Atherosclerosis Reports | Issue 11/2020

Abstract

Purpose of Review

High lipoprotein(a) (Lp(a)) level is an independent cardiovascular risk factor with higher prevalence among patients with atherosclerotic cardiovascular disease (ASCVD). The actual problem is that most currently available lipid-lowering drugs are unable to abolish Lp(a) pathogenicity. Lipoprotein apheresis (LA) is an effective method for elimination of atherogenic lipoproteins, but it is approved only in some countries for treatment of elevated Lp(a) level in the presence of progressive ASCVD. In recent years, new studies on LA were published and the purpose of this review is to present the information on optimal management of Lp(a) hyperlipoproteinemia by LA in the modern era.

Recent Findings

Most clinical studies designed to treat Lp(a) hyperlipoproteinemia with different LA systems are small in size but demonstrate that the elimination of Lp(a) from bloodstream leads to reduction of inflammatory and prothrombotic process in a few months and to atherosclerotic plaques regression in 1.5 years. Treatment with LA for 2 to 5 years in terms of clinical trials and in real-world setting provides further evidence that Lp(a) reduction by 60–80% is associated with proportional decreasing of rate and risk of cardiovascular events.

Summary

Specific Lp(a) apheresis is the only possible method that solely targets Lp(a). In most countries, non-specific LA is used for treatment Lp(a) hyperlipoproteinemia in very high-risk subjects with progressive ASCVD. PCSK9 inhibitors have only modest effect on significantly elevated Lp(a), whereas large population-based studies requested sustained and prolonged reduction of Lp(a) levels by 50–100 mg/dL to gain proportional decreasing of major adverse cardiovascular events.

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Title: Therapeutic Apheresis for Management of Lp(a) Hyperlipoproteinemia
Authors: Sergei N. Pokrovsky
Olga I. Afanasieva
Marat V. Ezhov
Publication date: 01-11-2020
Publisher: Springer US
Keywords: PCSK9 Inhibitor
Arterial Occlusive Disease
Published in: Current Atherosclerosis Reports / Issue 11/2020
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-020-00886-0

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