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Lipoprotein Apheresis for Lipoprotein(a)-Associated Cardiovascular Disease: Prospective 5 Years of Follow-Up and Apolipoprotein(a) Characterization
Open accessAbstract
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.
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“Two studies reported a significantly lower cardiovascular event rate in patients treated with lipid apheresis for Lp(a) [194, 195].”
From Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention (2023) · cites this paper as [195]
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Metadata
- Authors
- Roeseler, E., Julius, U., Heigl, F., Spitthoever, R., Heutling, D., Breitenberger, P., Leebmann, J., Lehmacher, W., Kamstrup, P. R., Nordestgaard, B. G., Maerz, W., Noureen, A., Schmidt, K., Kronenberg, F., Heibges, A., Klingel, R., Schettler, V., Benzing, T., Christ, H., Wehner, S., Schulz-Merkel, I., Kuehn, R., Wagner, A., Dschietzig, W., Ernst, C., Koziolek, M., Bunia, J., Kulzer, P., Kraenzle, K.-D., Toelle, M., Riechers, G., Kuehnel, C., Marsen, T., Saehn, C., Ringel, J., Messner, H., Oehring, A., Schuerfeld, C., Wintergalen, M., Schettler, V., Neumann, F., Kaul, H., Haesner, M., Passfall, J., Benschneider, A., Heidenreich, S., März, W., Klaes, R., Binner, P., Dieplinger, H., Erhart, G., Fassbender, C., & Christ, H.
- Affiliations
- Technische Universität Dresden (DE)
- From the Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany (E.R.); 3rd Medical Clinic, University Hospital at the Technische Universität, Dresden, Germany (U.J.); Medical Health and Care Center Kempten-Allgäu, Kempten, Germany (F.H.); Dialysis and Lipid Center North Rhine, Essen, Germany (R.S.); Clinic for Nephrology and Dialysis, Tangermuende, Germany (D.H.); KfH-Kidney Center, Germering, Germany (P.B.); 1st Medical Clinic, General Hospital, Passau, Germany (J.L.);...
- Cologne
- Hannover
- Kempten
- Tangermuende
- Trier
- Cottbus
- Goettingen
- Iserlohn
- Marktheidenfeld
- Memmingen
- Berlin
- Braunschweig
- Krefeld
- Potsdam
- Wuppertal
- Suhl
- Saarlouis
- Olpe
- Dresden
- Deggendorf
- Aachen
- Mannheim
- Innsbruck, Austria
- ORCID
- Venue
- Arteriosclerosis, Thrombosis, and Vascular Biology
- Published
- 2016-09
- Volume
- 36
- Issue
- 9
- Pages
- 2019-2027
- ISSN
- 1079-5642 (ISSN-L)
- 1524-4636
- OpenAlex
- W2556080334
- Semantic Scholar
- 012bba31547ed986fa3a0e3d76102f0991dd9ee5
- Cited by
- 227
- References
- 32
- Citations by year
- 2026: 18 · 2025: 15 · 2024: 21 · 2023: 32 · 2022: 20 · 2021: 20 · 2020: 16 · 2019: 36 · 2018: 16 · 2017: 30 · 2016: 2
- FWCI
- 30.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Arteriosclerosis Thrombosis and Vascular Biology (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
- Keywords
- lipoprotein apheresis, apolipoprotein(a), cardiovascular disease prevention, cardiovascular events, apolipoprotein(a) isoforms, rs10455872, rs3798220, cardiovascular risk, LDL cholesterol
- MeSH terms
- Aged, Blood Component Removal, Cardiovascular Diseases, Female, Follow-Up Studies, Germany, Humans, Hyperlipoproteinemias, Male, Middle Aged, Phenotype, Prospective Studies, Risk Factors, Time Factors, Biomarkers, Incidence, Treatment Outcome, Lipoprotein(a), Risk Assessment, Genetic Predisposition to Disease, Polymorphism, Single Nucleotide, Apoprotein(a)
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