Reduced incidence of cardiovascular events in hyper-Lp(a) patients on lipoprotein apheresis. The G.I.L.A. (Gruppo Interdisciplinare Aferesi Lipoproteica) pilot study. Issue 5 (October 2018)

• Record Type: Journal Article
• Authors: Bigazzi, Federico; Sbrana, Francesco; Berretti, Daniele; Maria Grazia, Zenti; Zambon, Sabina; Fabris, Antonia; Fonda, Maurizio; Vigna, Giovanni B.; D'Alessandri, Giovanna; Passalacqua, Stefano; Dal Pino, Beatrice; Pianelli, Mascia; Luciani, Roberta; Ripoli, Andrea; Rafanelli, Daniela; Manzato, Enzo; Cattin, Luigi; Sampietro, Tiziana
• Is Part Of: Transfusion and apheresis science. Volume 57:Issue 5(2018)
• Page Start: 661
• Page End: 664
• Publication Date: 2018-10
• Subjects: Lipoprotein apheresis -- Lp(a)-hyperlipoproteinemia -- Cardiovascular events; Blood -- Transfusion -- Periodicals; Hemapheresis -- Periodicals; 615.39
• DOI: 10.1016/j.transci.2018.07.015
• Languages: English
• ISSNs: 1473-0502

Abstract

Highlights: Lp(a) is a genetic risk factor for coronary artery disease. Lowering high Lp(a) plasma levels by lipoprotein apheresis in a multicenter study. Efficacy of lipoprotein apheresis on morbidity in patients with hyper-Lp(a). 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.