Eugenia Gianos, MD

Drs. Sperling and Gianos discuss future considerations for use of lipoprotein apheresis and the evolving landscape of lipid management.

HCPLive Special report Lipoprotein Apheresis Special Report Part 3

00:00 - Challenges and Barriers in Lipoprotein Apheresis

02:28 - Patient-facing and Clinician-Specific Perspectives

05:30 - Insurance and Health System Challenges 

12:07 - Final Thoughts and Recommendations

In contemporary settings within cardiology, the word 

 is enough to conjure excitement and enthusiasm. With the field on the cusp of a potential paradigm shift in the management of lipoprotein(a) [Lp(a)] within the next 18 months, many are optimistic about the potential for additional therapeutic options to improve outcomes in patients with elevated Lp(a).

What often goes unmentioned or overlooked in these conversations is the recognition of an existing US Food and Drug Administration-approved therapy for reducing Lp(a) in lipoprotein apheresis. Beyond this recognition, data and guidelines also support the role of lipoprotein apheresis in certain patients with familial hypercholesterolemia (FH).

The recognition of the potential utility of this therapy in this context and more was the subject of the latest 

scientific statement from the American Heart Association (AHA)

. Released on October 07, 2024, the statement, titled “Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association,”, clocks in at 18 pages and length and cites more than 100 references documents. Composed on behalf of several AHA councils, the document was created by a volunteer writing committee led by committee chair Laurence Sperling, MD, Katz Professor in Preventive Cardiology and founder of the Emory Center for Heart Disease Prevention, and vice-chair Eugenia Gianos, MD, director of Cardiovascular Prevention at Northwell Health.

In this, the third and final segment of this HCPLive Special Report, Sperling and Gianos discuss the evolution, challenges, and future of lipoprotein apheresis in treating patients with severe hypercholesterolemia. Sperling, who has overseen Emory’s lipoprotein apheresis program for more than 20 years, shares insights on the program’s expansion and the barriers faced in providing this treatment, which is currently available in only 33 US states. Sperling goes on to emphasizes the need for greater awareness among clinicians about the benefits of apheresis, which can drastically reduce LDL cholesterol and Lp(a) levels, improve patients' quality of life, and prevent cardiovascular events.

Gianos, who helped establish Northwell Health’s apheresis program, highlights the importance of balancing the inconvenience of frequent treatments with the long-term health benefits for patients. She also discusses the need for more research on patient experiences and the potential for the therapy to address not only lipid reduction but also inflammation and endothelial function. Both experts agree that while emerging therapies for Lp(a) are promising, apheresis remains a vital option for patients who do not respond optimally to existing treatments. Similarly, they both stress the importance of continued education and institutional support to ensure access to this life-saving therapy.

Clinical Application of Lipoprotein Apheresis

Laurence Sperling has no disclosures to report. Relevant disclosures for Gianos include Amgen, AstraZeneca, Eli Lilly and Company, kaenka, Novartis, and Med-IQ.

Gianos E, Duell PB, Toth PP, et al. Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. Published online October 7, 2024. doi:10.1161/ATV.0000000000000177

Iapoce C. AHA scientific statement promotes expanded use of lipoprotein apheresis. HCP Live. October 11, 2024. Accessed October 17, 2024. https://www.hcplive.com/view/aha-scientific-statement-promotes-expanded-use-of-lipoprotein-apheresis.

Videos

In part 3 of our Special Report on lipoprotein apheresis, Sperling and Gianos discuss future considerations for use and the evolving landscape of lipid management.

The Future of Lipoprotein Apheresis, with Laurence Sperling, MD, and Eugenia Gianos, MD

Drs. Sperling and Gianos highlight clinical considerations for use of lipoprotein apheresis in part 2 of a 3-part series.

HCPLive Special Report on Lipoprotein Apheresis Part 2

00:00 - Eligibility and Benefits of Lipoprotein Apheresis

02:14 - Steps for Identifying and Treating Patients 

03:44 - Data and Evidence Supporting Lipoprotein Apheresis 

07:44 - Additional Benefits and Mechanisms of Lipoprotein Apheresis

09:56 - Vascular and Nephrological Benefits

12:50 - Conclusion and Broader Applications

Despite offering the potential to improve outcomes in certain patients with

 and being the only therapeutic approach currently approved by the US Food and Drug Administration for lowering lipoprotein(a) [Lp(a)], lipoprotein apheresis goes underutilized in contemporary settings, according to 

 from the American Heart Association (AHA).

In recent years, a growing body of evidence has outlined the potential of this therapeutic approach, with this growth culminating in the release of the latest scientific statement from the AHA. Released on October 07, 2024 and titled “Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association,”, the document reviews the historical development, available devices, indications, efficacy, vascular effects, outcomes data, use in special populations, availability, access, cost, and patient perspectives on lipoprotein apheresis.

In recognition of the efforts of the AHA and the volunteer writing committee, 

 has launched the latest Special Report series spotlighting the scientific statement with writing committee chair Laurence Sperling, MD, Katz Professor in Preventive Cardiology and founder of the Emory Center for Heart Disease Prevention, and vice chair Eugenia Gianos, MD, director of Cardiovascular Prevention at Northwell Health.

In this segment, which is part 2 of our 3-part series, Sperling and Gianos discuss the benefits and challenges of lipoprotein apheresis as a treatment for patients with severe lipid disorders, particularly those with homozygous familial hypercholesterolemia and elevated Lp(a). Sperling, who helped establish Emory’s lipoprotein apheresis program, highlights how this procedure provides life-saving options for patients with genetic lipid conditions, especially those who do not respond to standard therapies due to non-functional LDL receptors.

Gianos delves into the clinical evidence supporting lipoprotein apheresis, noting that while randomized controlled trials are limited, observational data show significant cardiovascular event reductions, with some studies reporting up to a 95% decrease in events. They also discuss the unique ability of apheresis to not only lower LDL cholesterol but also reduce inflammation and improve endothelial function, which contributes to vascular healing.

The conversation touches on underexplored areas, such as the potential for using apheresis in patients with 

 and other challenging populations, including stroke patients and pediatric cases. Both experts emphasize the need for further research and collaboration with nephrologists and other specialists to expand the use of this therapy for broader patient groups.

Laurence Sperling has no disclosures to report. Relevant disclosures for Gianos include Amgen, AstraZeneca,Eli Lilly and Company, kaenka, Novartis, and Med-IQ.

Lipoprotein apheresis, though underutilized, is the only FDA-approved method for lowering lipoprotein(a) and offers potential benefits for patients with familial hypercholesterolemia. The American Heart Association's recent scientific statement reviews its efficacy, outcomes, and implementation. Experts highlight its life-saving potential for patients with severe lipid disorders, especially those unresponsive to standard therapies. Observational data suggest significant cardiovascular event reductions. The statement calls for further research and collaboration to explore its use in broader patient populations, including those with focal segmental glomerulosclerosis and pediatric cases.

In part 2 of this 3-part series, Sperling and Gianos highlight the role of lipoprotein apheresis in contemporary settings and the supporting evidence base. 

Optimizing Use and Clinical Considerations for Lipoprotein Apheresis, with Laurence Sperling, MD, and Eugenia Gianos, MD

Drs. Sperling and Gianos introduce the HCPLive Special Report on Lipoprotein Apheresis

HCPLive Lipoprotein Apheresis Special Report Part 1

00:00 - Introduction to the Scientific Statement on Lipoprotein Apheresis

01:25 - Importance of the Central Illustration in the Scientific Statement

03:17 - Historical Context and Evolution of Lipoprotein Apheresis

On October 07, 2024, the American Heart Association (AHA) 

 outlining the role and supporting data for using lipoprotein apheresis in clinical practice.

At 18 pages in length, citing 104 references, and featuring a multitude of charts and colorized graphics, the scientific statement’s specific aim is to provide an overview of the history of lipoprotein apheresis, mechanisms of action, cardiovascular and renal outcomes data, indications, and options for treatment. Composed on behalf of several AHA councils, including the Council on Arteriosclerosis, Thrombosis, and Vascular Biology; Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology, the document was created by a volunteer writing committee chaired by Laurence Sperling, MD, Katz Professor in Preventive Cardiology and founder of the Emory Center for Heart Disease Prevention.

, Sperling is joined by committee vice-chair Eugenia Gianos, MD, director of Cardiovascular Prevention at Northwell Health, for a deep dive into the AHA’s scientific statement, their personal experiences with lipoprotein apheresis, and future considerations in the evolving landscape of lipodology.

In the introduction video featured above, Sperling explains the importance of raising awareness of this underutilized treatment for patients with severe hypercholesterolemia, including familial hypercholesterolemia (FH) and elevated lipoprotein(a) [Lp(a)]. Gianos highlights key points from the statement, focusing on the specific patient populations that benefit most from this therapy, such as those with homozygous and heterozygous familial hypercholesterolemia, as well as those with elevated Lp(a) levels. Both experts emphasize the importance of the central illustration in the statement, which concisely presents the treatment’s benefits, including reductions in LDL, Lp(a), and inflammation markers.

The American Heart Association released a comprehensive scientific statement on October 7, 2024, detailing the role of lipoprotein apheresis in clinical practice. This document, created by a volunteer committee led by Dr. Laurence Sperling, aims to provide an overview of the treatment's history, mechanisms, and outcomes. It highlights the therapy's benefits for patients with severe hypercholesterolemia, including familial hypercholesterolemia and elevated lipoprotein(a) levels. The statement emphasizes the importance of raising awareness about this underutilized treatment and includes a central illustration summarizing its benefits.

Laurence Sperling, MD, and Eugenia Gianos, MD, discuss the historical context and underutilization of lipoprotein apheresis in part 1 of a 3-part video series.

Eugenia Gianos, MD

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