Toward an international consensus—Integrating lipoprotein apheresis and new lipid-lowering drugs

Abstract

Novel lipid-lowering agents have potential to improve the performance of LA, but more evidence is needed. The Multidisciplinary International Group for Hemapheresis TherapY and Metabolic DIsturbances Contrast scientific society aims to establish an international registry of clinical experience on LA combination therapy to expand the evidence on this treatment in individuals at high cardiovascular disease risk.

HEART UK consensus statement on Lipoprotein(a): A call to action

“…Although Lipoprotein(a) (Lp(a)) is now established as a causal risk factor for cardiovascular disease (CVD) [1][2][3], there is little consensus between the different national guidelines on how to use this information on Lp(a) to more accurately estimate and modify cardiovascular risk [4,5]. For instance, the 2012 Australian Guideline does not mention Lp(a) [6].…”

The dedicated “Lp(a) clinic”: A concept whose time has arrived?

“…There are currently six national/international guidelines or consensus statements in place to recommend Lp(a) testing/therapy, including the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) [22], the American Society For Apheresis [32], the American Society for American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [33], the Canadian Cardiovascular Society guidelines [34], the National Lipid Association guidelines and the HEART UK consensus statement on Lipoprotein(a) [35], summarized in Table 1. Although differences among guidelines exist, in general, increased risk is suggested to occur at > The justification for this was to identify subjects at significantly increased cardiovascular risk based on Lp(a) elevation.…”

“…These apparently conflicting recommendations on risk thresholds underline the common concept that marked Lp(a) elevation is a major CVD risk factor, mandating screening approaches similar to elevated LDL-C [22,33,34,36]. The American Society For Apheresis is the only body that has recommended therapy for elevated Lp(a), including niacin 1-3 g per day (not available in Europe) and lipid apheresis in patients with recurrent CVD-events and Lp(a) levels > 50 mg/dL (125 nmol/L) [32]. Furthermore, apheresis is reimbursed in Germany if a patient has recurrent events or progressive cardiovascular disease despite controlled LDL-C and elevated Lp (a) > 60 mg/dL.…”

What’s new on therapies for elevated lipoprotein(a)

“…Despite the strong positive association with ASCVD, plasma levels of Lp(a) are not routinely tested, nor are there any established or clinically approved drug treatments for lowering Lp(a) levels, with the exception of apheresis [33], which is approved in Germany and the US. Statin treatment does not appear to have any effect and there are reports that they may increase circulating levels of Lp(a) by 10-20%, contributing to increased residual risk [1], although the consistency of this claim remains to be confirmed.…”