Abstract
BackgroundLipoprotein(a) (Lp(a)) is a genetic risk factor for cardiovascular disease (CVD) and is associated with the induction and sustaining of atherosclerotic cardiovascular diseases (ASCVD). Since 2008 Lp(a) along with progressive CVD has been approved as an indication for regular lipoprotein apheresis (LA) in Germany. The German Lipoprotein Apheresis Registry (GLAR) has been initiated to provide statistical evidence for the assessment of extracorporeal procedures to treat dyslipidemia for both LDL-cholesterol (LDL-C) and Lp(a). The GLAR now allows prospective investigations over a 5-year period about annual incidence rates of cardiovascular events. Here Lp(a) patients (LDL-C < 100 mg/dl; Lp(a) > 60 mg/dl or >120 nmol/l) showed the same reduction of major coronary (83%) and non-coronary events (63%) as had been formerly shown in the Pro(a)LiFe study. However, Lp(a) is not only an apolipoprotein(a) (apo(a)) and LDL-C containing particle, which is covalently bound to a LDL-C core by a disulphide bridge. The composition of this particle, inter alia containing oxidized phospholipids, gives pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing atherosclerotic processes mainly in the arterial wall. However, recent investigations have shown that a reduction of inflammatory settings without LDL-C or Lp(a) reduction may reduce ASCVD events. Lipoprotein apheresis (LA) could not only reduce LDL-C and Lp(a) in parallel, but also different inflammatory and coagulation parameters. In summary lipoprotein apheresis is not only anti-atherosclerotic, but also anti-inflammatory and anti-thrombotic and therefore an ideal treatment option with respect to the shown reduction of major adverse coronary events (MACE) and major adverse non-coronary events (MANCE) by reducing Lp(a) levels.
Highlights
Atherosclerotic cardiovascular diseases (ASCVD) are the main cause of morbidity and mortality in western countries [1]
German apheresis centers collected retrospective and prospective observational data of 1632 patients undergoing lipoprotein apheresis (LA) to treat high LDL-C levels and/or high Lp(a) levels, who were suffering from progressive cardiovascular disease (CVD)
Patients with available data according to the query pattern in the period 2012–2017 were found to have a reduction in major adverse coronary events (MACE) of 83% (Fig. 1a)
Summary
Atherosclerotic cardiovascular diseases (ASCVD) are the main cause of morbidity and mortality in western countries [1]. Lp(a) is complex due to its composition of a low-density lipoprotein cholesterol (LDL-C) particle, in which apolipoprotein B is covalently bound to apolipoprotein(a), which contains different kringles with various characteristics [4]. These structures are responsible for its pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing ASCVD or calcific aortic valve stenosis (CAVS) [2]. Lp(a) is an apolipoprotein(a) (apo(a)) and LDL-C containing particle, which is covalently bound to a LDL-C core by a disulphide bridge The composition of this particle, inter alia containing oxidized phospholipids, gives pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing atherosclerotic processes mainly in the arterial wall. In summary lipoprotein apheresis is anti-atherosclerotic, and anti-inflammatory and anti-thrombotic and an ideal treatment option with respect to the shown reduction of major adverse coronary events (MACE) and major adverse non-coronary events (MANCE) by reducing Lp(a) levels
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