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News & Press: Clinical News

In patients with Lp(a)-HLP LA effectively lowered the incidence rate of cardiovascular events.

Thursday, September 26, 2013   (0 Comments)
Posted by: Sandra Tremulis
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Lipoprotein Apheresis in Patients with Maximally Tolerated Lipid Lowering Therapy, Lp(a)-Hyperlipoproteinemia and Progressive Cardiovascular Disease: Prospective Observational Multicenter Study

Josef Leebmann1; Eberhard Roseler2; Ulrich Julius3; Franz Heigl4; Ralf Spitthoever5; Dennis Heutling6; Paul Breitenberger7; Winfried Maerz8; Walter Lehmacher9; Andreas Heibges10; Reinhard Klingel10*; for the Pro(a)LiFe*-Study Group+ Author Affiliations 11st Medical Clinic, General Hospital, Passau, Germany  2Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany  33rd Medical Clinic, University Hospital, Dresden, Germany  4MVZ Kempten-Allgaeu, Kempten, Germany  5Dialysis- and Lipid Center North Rhine, Essen, Germany  6Clinic for Nephrology and Dialysis, Tangermuende, Germany  7KfH-Kidney Center, Germering, Germany  8Institute of Public Health and Preventive Medicine, University Heidelberg, Mannheim, and Synlab Academy, Mannheim, and Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria  9Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany  10Apheresis Research Institute, Cologne, Germany ↵* Apheresis Research Institute, Stadtwaldguertel 77, 50935 Cologne, Germany

Background—Lipoprotein(a)-hyperlipoproteinemia (Lp(a)-HLP) is a major risk factor for cardiovascular disease (CVD), which is not affected by treatment of other cardiovascular risk factors. This study sought to assess effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive CVD receiving maximally tolerated lipid lowering treatment. Methods and Results—In a prospective observational multicenter study 170 patients were investigated, who commenced LA due to Lp(a)-HLP and progressive CVD. Patients were characterized regarding plasma lipid status, lipid lowering drug treatment, and variants at the LPA gene locus. Incidence rate of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. Mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA mean LDL-C and Lp(a) were 2.56±1.04 mmol*l-1 (99.0±40.1 mg*dl-1) and Lp(a) 3.74±1.63 µmol*l-1 (104.9±45.7 mg*dl-1), respectively. Mean annual rates for major adverse coronary events (MACE) declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA (p<0.0001). Event rates including all vascular beds declined from 0.61 to 0.16 (p<0.0001). Analysis of single years revealed increasing MACE-rates from 0.30 to 0.54 (p=0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 (p<0.0001) and to 0.05 from y+1 to y+2 (p=0.014).

Conclusions—In patients with Lp(a)-HLP, progressive CVD and maximally tolerated lipid lowering medication LA effectively lowered the incidence rate of cardiovascular events.

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