Lipoprotein(a) apheresis in patients with peripheral arterial disease: rationale and clinical results

Abstract

Patients with symptomatic peripheral arterial disease (PAD) are at a very high risk of cardiovascular morbidity and mortality. Elevated lipoprotein(a) levels have been shown to be a risk factor for coronary artery disease (CAD) and stroke. More recently elevated lipoprotein(a) levels have also been demonstrated to be associated with prevalent and incident PAD, and even may be a stronger risk factor for PAD compared with CAD. Lipoprotein apheresis is currently the only efficient way to lower lipoprotein(a) levels. Lipoprotein(a) apheresis has been shown to reduce major coronary events in patients with CAD. There is increasing evidence that lipoprotein(a) apheresis also reduces the rate of major adverse limb events such as peripheral revascularizations and amputations in PAD patients, and improves symptoms of PAD such as pain on exertion. This review summarizes the current knowledge on the clinical role of lipoprotein(a) for PAD and the disease-specific effect of lipoprotein(a) apheresis, and suggests indications for screening for and treating of elevated lipoprotein(a) levels in patients with PAD.

Role of Lipid-Lowering Therapy in Peripheral Artery Disease

“…Prospective cohort studies strongly suggest a causal relationship between elevated Lp(a) levels and PAD. However, data on the efficacy of lipoprotein apheresis in patients with PAD and elevated Lp(a) are scarce [ 78 ]. The HORIZON trial is an ongoing clinical trial to assess the impact of LP(a) lowering with Pelacarsen (TQJ230) on MACE in patients with CV disease [ 79 ].…”

Precision Medicine Approach for Cardiometabolic Risk Factors in Therapeutic Apheresis

“…Therapeutic apheresis is an established treatment option for patients with severe lipid disorders, which could not be adequately treated by routine lipid-lowering measures. LA has been a powerful tool for retarding, preventing or even reducing the atherosclerotic process in patients with lipid disorders refractory to medical treatment [1][2][3]. Based on the new European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines most patients with familial hypercholesterolemia currently do not reach the LDL-C target values even on a maximal dosage of statin/ ezetimibe.…”

“…Therapeutic apheresis is a well-established treatment approach for patients with severe lipid disorders and high cardiovascular risk profiles [1][2][3]. LA should start as fast as possible when the admission criteria are met to avoid new cardiovascular events [4].…”

Principal predictors of major adverse limb events in diabetic peripheral artery disease: A narrative review

“…MALE: Major Adverse Limb Event; LDL-c: Low-Density Lipoprotein cholesterol; Lp(a): Lipoprotein-a; MACE: Major Adverse Cardio/Cerebrovascular Event; IL-6: Interleukine-6; CRP: C Reactive Protein; TNF-a: Tumor Necrosis Factor-a; OPG: Osteoprotegerin; ABI: Ankle-Brachial Index. Macro area Micro area References Unmodifiable risk factors Age [ 36 , 63 , 64 ] Modifiable risk factors Smoking [ 72 , [80] , [81] , [82] ] Disease and organic risk factors Diabetes mellitus [ 55 , 65 , 66 , 69 , 74 ] Hypertension [ 72 , 80 ] Dyslipidemia [LDL-c, Lp(a)] [ 80 , [89] , [90] , [91] , [92] , 95 , 96 , 103 , [106] , [107] , [108] , [109] ] Chronic kidney disease [ 55 , 72 , 81 , 138 , 139 ] Lower limb neuropathy [ [147] , [148] , [149] , [150] ] Microangiopathy …”