Lipoprotein apheresis in patients with peripheral artery disease and hyperlipoproteinemia(a)

Poller, Wolfram C.; Dreger, Henryk; Morgera, Stanislao; Berger, Axel; Flessenkämper, I.; Enke-Melzer, Kathrin

doi:10.1016/j.atherosclerosissup.2015.02.032

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…Currently, only LPA apheresis is a proved therapy to reduce LPA levels by more than 60% per session thus having a positive influence on the reduction of cardiovascular events [33–37]. …”

Section: Discussionmentioning

confidence: 99%

Incidence of elevated lipoprotein (a) levels in a large cohort of patients with cardiovascular disease

Buuren

Horstkotte

Knabbe

et al. 2017

Clin Res Cardiol Suppl

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BackgroundRecently it has been demonstrated that elevated lipoprotein (a) (LPA) levels are associated with an increased risk of cardiovascular disease across multiple ethnic groups. However, there is only scanty data about the incidence of elevated LPA levels in different patient cohorts. As a consequence, we aimed to examine whether patients with elevated LPA levels might be seen more often in a cardiovascular center in comparison to the general population.MethodsWe reviewed LPA concentrations of 52,898 consecutive patients who were admitted to our hospital between January 2004 and December 2014. We subdivided them into different groups according to their LPA levels. Data was compared to available information in medical literature.Results26.4% of the patients had LPA levels >30 mg/dl which is in line with the data from literature. Mean level of LPA concentration in our study was twice as high in comparison to the general population (25.8% vs. 13.3%). 4.6% had LPA levels >98 mg/dl (general population <0.3%).ConclusionIn patients admitted to a cardiovascular center the proportion of LPA >30 mg/dl is comparable to the general population but mean levels over all are twice as high and the proportion of patients with LPA levels of >98 mg/dl is extremely higher.

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“…Currently, only LPA apheresis is a proved therapy to reduce LPA levels by more than 60% per session thus having a positive influence on the reduction of cardiovascular events [33–37]. …”

Section: Discussionmentioning

confidence: 99%

Incidence of elevated lipoprotein (a) levels in a large cohort of patients with cardiovascular disease

Buuren

Horstkotte

Knabbe

et al. 2017

Clin Res Cardiol Suppl

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“…ABI significantly increased after LA sessions, which is consistent with previous reports 8,15,21) . Although several studies on patients with dyslipoproteinemia have shown that continuous LA treatment results in a plaque reduction in the coronary 33,34) and peripheral arteries 10) , at least 1-2 years are required for such an effect. Therefore, the increase in ABI observed in this study may not reflect a reduction in the stenotic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Lipoprotein apheresis (LA) was developed to remove atherogenic lipoproteins from circulation 5,6) . It is an established treatment for PAD that is complicated by severe hypercholesterolemia 7,8) or elevated lipoprotein (a) 9,10) . Due to the strict target serum cholesterol level recommended for this population 11,12) and the current progress in lipidlowering medications, most patients with PAD are without such conditions 13,14) .…”

Section: Lipoprotein Apheresismentioning

confidence: 99%

Lipoprotein Apheresis Alleviates Treatment-Resistant Peripheral Artery Disease Despite the Normal Range of Atherogenic Lipoproteins: The LETS-PAD Study

Ueda,

Toya,

Wakui

et al. 2024

JAT

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Aim: Peripheral artery disease (PAD) severely impairs patient prognosis and quality of life (QOL). Although lipoprotein apheresis (LA) has been applied to patients with PAD and elevated serum atherogenic lipoproteins, we hypothesized that LA can be effective for treating PAD even in patients with controlled serum lipoproteins through pleiotropic anti-atherosclerotic effects beyond lipoprotein removal. This study aimed to evaluate the efficacy of LA in patients with treatment-resistant PAD and controlled serum lipoproteins focusing on QOL. Methods: In a single-arm prospective study, 30 patients with refractory PAD who had controlled serum lipoproteins underwent sequential LA sessions using dextran sulfate adsorption columns, aiming to complete 10 sessions. The ankle-brachial pressure index (ABI) and vascular QOL (VascuQOL) score were evaluated as the primary outcomes. Secondary outcomes included reactive hyperemia index (RHI) and biological antioxidant potential (BAP) as an endothelial function test and serum antioxidative-capacity evaluation, respectively. Results: ABI significantly increased after LA sessions (pre-treatment 0.60±0.09 vs. post-treatment 0.65±0.13, p = 0.023). Total VascuQOL score (3.7±1.1 vs 4.6±1.1, p＜0.001) and RHI (1.70±0.74 vs 2.34±1.76, p = 0.023) significantly improved after the LA sessions. BAP tended to increase after the LA sessions, and the change reached statistical significance 3 months after treatment. Conclusion: ABI and QOL improved after a series of LA sessions in conventional treatment-resistant PAD patients with controlled serum lipoprotein levels. Increased antioxidative capacity and ameliorated endothelial function were observed after the LA treatment.

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“…There is increasing evidence from case-control studies, cross-sectional cohort studies and longitudinal prospective cohort studies that elevated lipoprotein(a) levels are a risk factor for the development of PAD and for a worse clinical outcome in PAD patients [11][12][13][14][15][16][17][18]. Furthermore, longitudinal observational studies indicated that lipoprotein apheresis also reduces the necessity for clinically driven revascularizations in patients with PAD [21,23,[25][26][27]. Whether or not it also reduces the extremely high burden of overall cardiovascular morbidity and mortality in PAD patients that is higher compared with patients with isolated CAD [8,9] has not been studied so far but seems to be biologically plausible.…”

Section: Discussionmentioning

confidence: 99%

“…Poller and coworkers [26,27] prospectively followed 10 patients who were treated by lipoprotein apheresis due to symptomatic PAD that required a revascularization procedure, had elevated lipoprotein(a) levels above 60 mg/dL and were on sufficient treatment of all other cardiovascular risk factors. Outcome measures were the rate of clinically driven revascularizations in the 12 months prior compared with the 24 months after initiation of lipoprotein apheresis as well as the ankle-brachial blood pressure index, the walking distance determined by a standardized treadmill test, as well as subjective grading of the mean pain level during everyday physical activity on a 10-point visual analogue scale (the higher the score the worse the pain).…”

Section: Efficacy Of Lipoprotein(a) Apheresis In Patients With Periphmentioning

confidence: 99%

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

Weiss

Julius

2019

Clin Res Cardiol Suppl

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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.

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Lipoprotein apheresis in patients with peripheral artery disease and hyperlipoproteinemia(a)

Cited by 9 publications

References 27 publications

Incidence of elevated lipoprotein (a) levels in a large cohort of patients with cardiovascular disease

Incidence of elevated lipoprotein (a) levels in a large cohort of patients with cardiovascular disease

Lipoprotein Apheresis Alleviates Treatment-Resistant Peripheral Artery Disease Despite the Normal Range of Atherogenic Lipoproteins: The LETS-PAD Study

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

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