Federico Bigazzi1, Francesco Sbrana1, Daniele Berretti2, Zenti Maria Grazia3, Sabina Zambon4, Antonia Fabris5, Maurizio Fonda6, Giovanni B Vigna7, Giovanna D'Alessandri2, Stefano Passalacqua8, Beatrice Dal Pino1, Mascia Pianelli1, Roberta Luciani1, Andrea Ripoli1, Daniela Rafanelli2, Enzo Manzato4, Luigi Cattin6, Tiziana Sampietro9. 1. U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1 - 56124 Pisa, Italy. 2. Immunohematology and Transfusion Medicine, ASL3, Pistoia, Italy. 3. U.O. Endocrinologia, Diabetologia e Malattie del Metabolismo, Università degli studi di Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani, 1 -37126 Verona, Italy. 4. Centro Dislipidemie e Aterosclerosi U.O. Clinica Medica 1, Azienda Ospedaliera Università degli Studi di Padova, Via Giustiniani, 2 - 35128, Padova, Italy. 5. U.O. Nefrologia e Dialisi, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani, 1 -37126 Verona, Italy. 6. Centro per lo Studio delle Malattie Dismetaboliche e dell'Arteriosclerosi, Ospedale di Gattinara - U.O. di Clinica Medica, Dipartimento di Scienze Cliniche, Morfologiche e Tecnologiche, Strada di Fiume, 447 - 34149, Trieste, Italy. 7. Department of Medical Sciences, University of Ferrara, Ferrara, Italy. 8. U.O.C. di Nefrologia e Dialisi, Fondazione Policlinico Universitario A. Gemelli, Via Giuseppe Moscati, 35 - 00168 Roma, Italy. 9. U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1 - 56124 Pisa, Italy. Electronic address: tiziana.sampietro@ftgm.it.
Abstract
BACKGROUND: Lipoprotein apheresis (LA) is the elective therapy for homozygous and other forms of Familial Hypercholesterolemia, Familial Combined Hypercholesterolemia, resistant/intolerant to lipid lowering drugs, and hyper-lipoproteinemia(a). Lipoprotein(a) [Lp(a)] has been classified as the most prevalent genetic risk factor for coronary artery disease and aortic valve stenosis. AIM: Our multicenter retrospective study has the aim to analyze the incidence of adverse cardiovascular events (ACVE) before and during the LA treatment, in subjects with elevated level of Lp(a) (>60 mg/dL) [hyper-Lp(a)] and chronic ischemic heart disease. METHODS: We collected data of 23 patients (mean age 63 ± 9 years, male 77%; from hospital of Pisa 11/23, Pistoia 7/23, Verona 2/23, Padova 2/23 and Ferrara 1/23), with hyper-Lp(a), pre-apheresis LDL-cholesterol <100 mg/dL, cardiovascular disease, on maximally tolerated lipid lowering therapy and LA treatment (median 7 years, interquartile range 3-9 years). The LA treatment was performed by heparin-induced LDL precipitation apheresis (16/23), dextran-sulphate (4/23), cascade filtration (2/23) and immunoadsorption (1/23). The time lapse between first cardiovascular event and beginning of apheresis was 6 years (interquartile range 1-12 years). RESULTS: The recorded ACVE, before and after the LA treatment inception, were 40 and 10 respectively (p < 0.05), notably, the AVCE rates/year were 0.43 and 0.11 respectively (p < 0.05) with a 74% reduction of event occurrence. CONCLUSIONS: Our data confirm long-term efficacy and positive impact of LA on morbidity in patients with hyper-Lp(a) and chronic ischemic heart disease on maximally tolerated lipid lowering therapy.
BACKGROUND: Lipoprotein apheresis (LA) is the elective therapy for homozygous and other forms of Familial Hypercholesterolemia, Familial Combined Hypercholesterolemia, resistant/intolerant to lipid lowering drugs, and hyper-lipoproteinemia(a). Lipoprotein(a) [Lp(a)] has been classified as the most prevalent genetic risk factor for coronary artery disease and aortic valve stenosis. AIM: Our multicenter retrospective study has the aim to analyze the incidence of adverse cardiovascular events (ACVE) before and during the LA treatment, in subjects with elevated level of Lp(a) (>60 mg/dL) [hyper-Lp(a)] and chronic ischemic heart disease. METHODS: We collected data of 23 patients (mean age 63 ± 9 years, male 77%; from hospital of Pisa 11/23, Pistoia 7/23, Verona 2/23, Padova 2/23 and Ferrara 1/23), with hyper-Lp(a), pre-apheresis LDL-cholesterol <100 mg/dL, cardiovascular disease, on maximally tolerated lipid lowering therapy and LA treatment (median 7 years, interquartile range 3-9 years). The LA treatment was performed by heparin-induced LDL precipitation apheresis (16/23), dextran-sulphate (4/23), cascade filtration (2/23) and immunoadsorption (1/23). The time lapse between first cardiovascular event and beginning of apheresis was 6 years (interquartile range 1-12 years). RESULTS: The recorded ACVE, before and after the LA treatment inception, were 40 and 10 respectively (p < 0.05), notably, the AVCE rates/year were 0.43 and 0.11 respectively (p < 0.05) with a 74% reduction of event occurrence. CONCLUSIONS: Our data confirm long-term efficacy and positive impact of LA on morbidity in patients with hyper-Lp(a) and chronic ischemic heart disease on maximally tolerated lipid lowering therapy.