Treatment of symptomatic hyperLp(a)lipidemia with LDL-apheresis vs. usual care

Stefanutti, C.; Vivenzio, A.; Di Giacomo, S.; Mazzarella, B.; Ferraro, P.M.; Abbolito, S.

doi:10.1016/j.transci.2009.10.003

« Previous Next »Transfusion and Apheresis Science
Volume 42, Issue 1 , Pages 21-26, February 2010

Treatment of symptomatic hyperLp(a)lipidemia with LDL-apheresis vs. usual care

C. Stefanutti
- Plasmapheresis Unit, Department of Medical and Clinical Therapy, University of Rome ‘La Sapienza’, ‘Umberto I’, Hospital, 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.
A. Vivenzio
- Plasmapheresis Unit, Department of Medical and Clinical Therapy, University of Rome ‘La Sapienza’, ‘Umberto I’, Hospital, Italy
S. Di Giacomo
- Plasmapheresis Unit, Department of Medical and Clinical Therapy, University of Rome ‘La Sapienza’, ‘Umberto I’, Hospital, Italy
B. Mazzarella
- Plasmapheresis Unit, Department of Medical and Clinical Therapy, University of Rome ‘La Sapienza’, ‘Umberto I’, Hospital, Italy
P.M. Ferraro
- Renal Unit, Catholic University of the Sacred Heart of Rome, Rome, Italy
S. Abbolito
- Department of Cardiology, University of Rome ‘La Sapienza’, Saint Andrew Hospital, Rome I-EU, Italy

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.

Keywords: HyperLp(a)lipoproteinemia, LDL-apheresis, Coronary artery disease, Coronary angiography