Treatment of symptomatic hyperLp(a)lipidemia with LDL-apheresis vs. usual care
Received 23 December 2008; received in revised form 11 February 2009; accepted 9 March 2009.
Abstract
Background/aims
To assess LDL-apheresis efficacy to lower Lp(a) and to compare the effects of Usual Medical Care (UMC) a 12-months study was carried out. The incidence of new coronary artery disease (CAD) events/need of revascularization, was also monitored.
Methods
Twenty-one patients with hyperLp(a)lipidemia and angiographically documented CAD were randomly assigned to LDL-apheresis every week, or the UMC.
Results
LDL-apheresis group, averaged an Lp(a) reduction of 57.8±9.5% vs. basal values (P<0.001). In the UMC group Lp(a) increased in 1year to 14.7±36.5% (P=0.66). Stepwise multivariate regression analysis for predictors of Lp(a) including: type of treatment, smoking, hypertension, age, age at first cardiovascular event, initial Lp(a), LDL, and BMI values, was performed. Only the type of treatment was co-related (P<0.001): Lp(a) variation (beta)=0.863. The model has R2 adjusted relative risk of 0.725.
Conclusion
LDL-apheresis could be the first line treatment of isolated hyperLp(a)lipidemia when CAD is established. New CAD events/cardiac interventions were not observed.
aPlasmapheresis Unit, Department of Medical and Clinical Therapy, University of Rome ‘La Sapienza’, ‘Umberto I’, Hospital, Italy
bRenal Unit, Catholic University of the Sacred Heart of Rome, Rome, Italy
cDepartment of Cardiology, University of Rome ‘La Sapienza’, Saint Andrew Hospital, Rome I-EU, Italy
Corresponding author. Address: Department of Clinical and Medical Therapy, Plasmapheresis Unit, University of Rome ‘La Sapienza’, ‘Umberto I’ Hospital, 155, Viale del Policlinico, I-00161 Rome, Italy. Tel.: +39 06 49970578; fax: +39 06 49972630.
ABSTRACT