Long Term Lipoprotein Apheresis Can Reduce Cardiovascular Events for Patients with Elevated Lp(a)

A new study from investigators in Germany is providing insight into the long-term effects of lipoprotein apheresis among patients with elevated lipoprotein(a) [Lp(a)].

In a study of 25 individuals with isolated Lp(a) elevation, results suggest lipoprotein apheresis was associated with reductions in median Lp(a), mean LDL-C, and cardiovascular events among patients with an indication for the treatment.¹

“Our long-term observation indicated that patients receiving lipoprotein apheresis for elevated Lp(a) exhibited a lower rate of cardiovascular events after initiation of the therapy compared to their pre-therapy status,” wrote investigators.¹ “It’s important to note that, as an observational study, this does not establish a causal relationship between lipoprotein apheresis and the reduction in cardiovascular event rates. Rather, these findings suggest a correlation that warrants further investigation.”

Lp(a) has been thrust into the spotlight by recent revelations surrounding its association with risk of major adverse cardiovascular events and propelled even further by promise of agents in the therapeutic pipeline, such as olpasiran, pelacarsen, and SLN360. At present, there are no FDA-approved pharmacologic treatments specifically indicated for addressing elevated Lp(a).²

Still, clinicians are not completely without means to address elevated Lp(a). In their 2024 update on Lp(a) in clinical practice, the National Lipid Association provides an overview of the effects of potential treatment options for elevated Lp(a), including lipoprotein apheresis.³

In the current study, Friederike Schumann, MD, and colleagues at the Charité – Universitätsmedizin Berlin sought to report their long-term experience with lipoprotein apheresis in patients with Lp(a) receiving care at the institution’s outpatient lipid clinic. Though a search of patients with Lp(a) greater than 60 mg/dL and LDL-C less than 2.59 mmol/L who received lipoprotein apheresis between 1996 and 2021, investigators identified 25 individuals for inclusion in their study.¹

This cohort was 84% male, had a mean baseline BMI of 27.8 (Standard Deviation [SD], 4.5) kg/m2, mean age at apheresis start of 59 (SD, 10.3) years, and a mean apheresis treatment duration of 7.1 (SD, 5.7) years. A total of 326 patient-years were included, with 179 treatment years and 148 pre-treatment years included in the investigators’ analyses.¹

The primary outcome of interest for the study was the incidence of any cardiovascular event, which included myocardial infarction, transient ischemic attack, stroke, occlusive peripheral artery disease, coronary artery bypass graft, percutaneous transluminal angioplasty, and diagnostic coronary angiography with document progress but without intervention. Investigators noted all patients included in the study received lipoprotein apheresis regularly once a week.¹

Upon analysis, results indicated the rate of cardiovascular events per year fell from 0.87 events per patient per year in the pre-treatment period to 0.24 during the on-treatment period (-0.63, P = .001). Additional analysis suggested the yearly rate of major adverse cardiovascular events was reduced from 0.34 to 0.006 (-0.33; P = .0002). Investigators highlighted similar results were observed in subgroup analyses stratified by baseline LDL-C below 1.42 mmol/L.¹

Investigators pointed out the median Lp(a) level among patients was reduced from 95.0to 31.1 mg/dL after beginning lipoprotein apheresis (-67.3%; P <.0001). When assessing LDL-C level, a reduction from 1.85 to 0.76 mmol/L was observed following initiation of lipoprotein apheresis (-58.9%; P <.0001).¹

“Even as new therapies emerge, lipoprotein apheresis will continue to serve as a valuable alternative treatment for patients who fail to achieve lipid goals despite undergoing maximum lipid-lowering therapy or for those who experience in tolerance to lipid-lowering drugs,” investigators wrote.¹

References:

1. Schumann F, Kassner U, Spira D, et al. Long-term lipoprotein apheresis reduces cardiovascular events in high-risk patients with isolated lipoprotein(a) elevation. Journal of Clinical Lipidology. Published online April 27, 2024. doi:10.1016/j.jacl.2024.04.134
2. Thau H, Neuber S, Emmert MY, Nazari-Shafti TZ. Targeting Lipoprotein(a): Can RNA Therapeutics Provide the Next Step in the Prevention of Cardiovascular Disease?. Cardiol Ther. 2024;13(1):39-67. doi:10.1007/s40119-024-00353-w
3. Koschinsky ML, Bajaj A, Boffa MB, et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol. Published online March 29, 2024. doi:10.1016/j.jacl.2024.03.001