Lipoprotein-apheresis: Austrian consensus on indication and performance of treatment

Abstract

The prevalence of familial disorders of lipid metabolism in Europe is higher than believed so far. In severely affected patients in whom conventional combined lipid lowering agents are insufficient to achieve target values, patients being intolerant to all the available members of the statin family as well as in patients with elevated lipoprotein(a) (100 mg/dl) and progression of atherosclerotic vascular disease, despite even normal low-density lipoproteins (LDL)-cholesterol values, lipoprotein-apheresis treatment is indicated. The Austrian Apheresis Consensus compares the inclusion criteria for patients to be treated in Austria with those from Italy, Germany, Spain, Japan, UK and the United States. The cut off level of 100 mg/dl for lipoprotein(a) is higher in Austria as compared to the aforementioned countries (50 or 60 mg/dl, respectively). The available clinical data reveal that regular weekly lipoprotein apheresis not only results in a significant lowering of the respective atherogenic lipid and lipoprotein parameters, but also in a significant decrease in clinical events and interventions. The underlying mechanisms such as non-lipid effects, side effects as well as the different available treatment principles are compared. For patients meeting the inclusion criteria, lipoprotein apheresis is a safe and effective therapy significantly reducing vascular events.

Cardiovascular events in patients with familial hypercholesterolemia and hyperlipoproteinaemia (a): Indications for lipoprotein apheresis in Poland

“…LA is available in 60% of 63 countries worldwide, and each country employs a different LA approach and indications 20,21 . The two main common indications are hyper‐Lp(a) and severe hypercholesterolemia.…”

“…LA was initiated as in our previously published studies and based on the following recommendations 21,23‐32 :…”

“…LA therapy is available in many countries across the world with varying inclusion criteria 18‐22 . Severe FH is an established therapeutic approach with different cut‐offs for LDL‐C.…”

Lipoprotein(a)—antisense therapy

“…Lipoprotein apheresis (LA) as an extracorporeal method lowers LDL-c and Lp(a) acutely and significantly by 60-70% but has to be applied regularly (mostly weekly). Few countries consider high levels of Lp(a) to be an indication for lipoprotein apheresis in very high-risk patients if all other cardiovascular risk factors, mainly LDL-c, are treated optimally [24][25][26][27].…”

The use of lipoprotein apheresis for the treatment of high-risk patients with elevated lipoprotein(a) and hypercholesterolemia

“…This can be considered as one of the specific mechanisms of influence on the development of atherosclerosis [20,21] . This problem is managed by lipoprotein apheresis [22][23][24] .…”