Patrick M Moriarty1, Jessica V Gray2, Lauryn K Gorby2. 1. Division of Clinical Pharmacology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA. Electronic address: PMORIART@kumc.edu. 2. Division of Clinical Pharmacology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Abstract
BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD). In the United States, lipoprotein apheresis (LA) therapy is approved for patients with familial hypercholesterolemia. Germany uses LA therapy for patients with an Lp(a) > 60 mg/dL, normal low-density lipoprotein cholesterol (LDL-C) levels, and CVD. LA therapy in this population demonstrated a >70% reduction in CVD events. In the United States, LA is only approved for patients with elevated LDL-C levels, regardless of Lp(a) level. OBJECTIVE: The objective of the study was to evaluate clinical significance of Lp(a) reduction with LA therapy in the United States. METHODS: A retrospective cohort study at one LA site in the United States evaluated 14 CVD patients with elevated Lp(a) and near normal LDL-C levels. Patient data was analyzed to demonstrate possible clinical benefit in reducing Lp(a) levels with LA to mitigate risk of major adverse cardiovascular events. RESULTS: Pre-LA patients' mean LDL-C and Lp(a) were 80 mg/dL and 138 mg/dL, respectively. LA therapy demonstrated a reduction of mean LDL-C to 29 mg/dL and Lp(a) to 51 mg/dL. These represent a percent reduction of 64% and 63% for LDL-C and Lp(a), respectively. There was a 94% reduction in major adverse cardiovascular events over a mean treatment period of 48 months. CONCLUSION: The treatment of CVD patients with an elevated Lp(a) and near normal LDL-C with LA in a U.S. treatment center demonstrated a significant reduction in future CVD events. LA should be considered for patients in the United States suffering from an elevated Lp(a) and progressive CVD.
BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD). In the United States, lipoprotein apheresis (LA) therapy is approved for patients with familial hypercholesterolemia. Germany uses LA therapy for patients with an Lp(a) > 60 mg/dL, normal low-density lipoprotein cholesterol (LDL-C) levels, and CVD. LA therapy in this population demonstrated a >70% reduction in CVD events. In the United States, LA is only approved for patients with elevated LDL-C levels, regardless of Lp(a) level. OBJECTIVE: The objective of the study was to evaluate clinical significance of Lp(a) reduction with LA therapy in the United States. METHODS: A retrospective cohort study at one LA site in the United States evaluated 14 CVDpatients with elevated Lp(a) and near normal LDL-C levels. Patient data was analyzed to demonstrate possible clinical benefit in reducing Lp(a) levels with LA to mitigate risk of major adverse cardiovascular events. RESULTS: Pre-LA patients' mean LDL-C and Lp(a) were 80 mg/dL and 138 mg/dL, respectively. LA therapy demonstrated a reduction of mean LDL-C to 29 mg/dL and Lp(a) to 51 mg/dL. These represent a percent reduction of 64% and 63% for LDL-C and Lp(a), respectively. There was a 94% reduction in major adverse cardiovascular events over a mean treatment period of 48 months. CONCLUSION: The treatment of CVDpatients with an elevated Lp(a) and near normal LDL-C with LA in a U.S. treatment center demonstrated a significant reduction in future CVD events. LA should be considered for patients in the United States suffering from an elevated Lp(a) and progressive CVD.
Authors: Filip M Szymański; Agnieszka Mickiewicz; Grzegorz Dzida; Iwona Gorczyca-Głowacka; Dariusz Kozłowski; Krystyna Widecka; Zbigniew Krasiński; Adam Kobayashi; Dagmara Hering; Katarzyna Mizia-Stec; Jarosław D Kasprzak; Tomasz Zubilewicz; Krzysztof Narkiewicz; Marek Koziński; Anna E Płatek; Anna Ryś-Czaporowska; Beata Chełstowska; Stefan Grajek; Marcin Wełnicki; Artur Mamcarz; Marcin Barylski; Beata Wożakowska-Kapłon; Miłosz J Jaguszewski; Marcin Gruchała; Krzysztof J Filipiak Journal: Cardiol J Date: 2021-11-23 Impact factor: 2.737