Lipoprotein Apheresis for Lipoprotein(a)-Associated Cardiovascular Disease: Prospective 5 Years of Follow-Up and Apolipoprotein(a) Characterization. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Roeseler, Eberhard; Julius, Ulrich; Heigl, Franz; Spitthoever, Ralf; Heutling, Dennis; Breitenberger, Paul; Leebmann, Josef; Lehmacher, Walter; Kamstrup, Pia R.; Nordestgaard, Børge G.; Maerz, Winfried; Noureen, Asma; Schmidt, Konrad; Kronenberg, Florian; Heibges, Andreas; Klingel, Reinhard; Schettler, Volker; Benzing, Thomas; Christ, Hildegard; Wehner, Sabine; Schulz-Merkel, Ines; Kuehn, Ralf; Wagner, Albrecht; Dschietzig, Wilfried; Ernst, Claudia; Koziolek, Michael; Bunia, Johannes; Kulzer, Peter; Kraenzle, Klaus-Dieter; Toelle, Markus; Riechers, Gerhard; Kuehnel, Christine; Marsen, Tobias; Saehn, Christina; Ringel, Jens; Messner, Harald; Oehring, Andreas; Schuerfeld, Carsten; Wintergalen, Michael; Schettler, Volker; Neumann, Falko; Kaul, Harald; Haesner, Martin; Passfall, Juergen; Benschneider, Andrea; Heidenreich, Stefan; März, Winfried; Klaes, Ruediger; Binner, Priska; Dieplinger, Hans; Erhart, Gertraud; Fassbender, Cordula; Christ, Hildegard;
• Is Part Of: Arteriosclerosis, thrombosis, and vascular biology. Volume 36:Issue 9(2016)
• Publication Date: 2016-09
• Subjects: cardiovascular disease -- coronary disease -- lipoprotein(a) -- lipoprotein apheresis -- risk factors; Arteriosclerosis -- Periodicals; Thrombosis -- Periodicals; Blood-vessels -- Pathophysiology -- Periodicals; Electronic journals; 616.13
• DOI: 10.1161/ATVBAHA.116.307983
• Languages: English
• ISSNs: 1079-5642

Abstract

Abstract : Objective—: Lipoprotein(a)-hyperlipoproteinemia (Lp(a)-HLP) along with progressive cardiovascular disease has been approved as indication for regular lipoprotein apheresis (LA) in Germany since 2008. We aimed to study the long-term preventive effect of LA and to assess hypothetical clinical correlations of apolipoprotein(a) (apo(a)) by analyzing genotypes and phenotypes. Approach and Results—: This prospective observational multicenter study included 170 patients with Lp(a)-HLP and progressive cardiovascular disease (48.9 years median age at diagnosis) despite other cardiovascular risk factors, including low-density lipoprotein cholesterol had maximally been treated (mean baseline low-density lipoprotein cholesterol: measured, 2.56 mmol/L [98.9 mg/dL] and corrected, 1.72 mmol/L [66.3 mg/dL]). Patients were prospectively investigated during a 5-year period about annual incidence rates of cardiovascular events. In addition, apo(a) isoforms and polymorphisms at the apo(a) gene ( LPA ) were characterized. One hundred fifty-four patients (90.6%) completed 5 years of follow-up. Mean Lp(a) concentration before commencing regular LA was 108.1 mg/dL. This was reduced by a single LA treatment by 68.1% on average. Significant decline of the mean annual cardiovascular event rate was observed from 0.58±0.53 2 years before regular LA to 0.11±0.15 thereafter ( P <0.0001); 95.3% of patients expressed at least 1 small apo(a) isoform. Small apo(a) isoform (35.2%) carrying phenotypes were not tagged by single-nucleotide polymorphisms rs10455872 or rs3798220. Conclusions—: Results of 5 years of prospective follow-up confirm that LA has a lasting effect on prevention of cardiovascular events in patients with Lp(a)-HLP. Patients clinically selected by progressive cardiovascular disease were characterized by a highly frequent expression of small apo(a) isoforms. Only Lp(a) concentration seemed to comprehensively reflect Lp(a)-associated cardiovascular risk, however. Abstract : Supplemental Digital Content is available in the text.