Key result
Lipoprotein apheresis lowered Lp(a) plasma levels by 74% and reduced major adverse cardiac events from 142 to 31 over two years, yielding a number needed to treat of 3.
Why the study?
Does chronic lipoprotein apheresis reduce cardiovascular events in patients with Lp(a)-hyperlipoproteinemia and progressive cardiovascular disease?
Observational (n=170)
Yes
Does chronic lipoprotein apheresis reduce cardiovascular events in patients with Lp(a)-hyperlipoproteinemia and progressive cardiovascular disease?
Effect estimate: NNT 3
Absolute Event Rate: 31% vs 142%
Lipoprotein apheresis significantly reduces Lp(a) levels and the incidence of cardiovascular events in high-risk patients with progressive cardiovascular disease and elevated Lp(a).
May warrant consideration in refractory cases; leaves open need for randomized confirmation before practice change.
Elevated lipoprotein(a) (Lp(a)) has emerged as an important independent cardiovascular risk factor, and causal association has been accepted with adverse outcome in atherosclerotic disease. Lipoprotein apheresis (LA) can lower low-density lipoprotein (LDL)-cholesterol and Lp(a) by 60-70 % and is the final escalating therapeutic option in patients with hyperlipoproteinemias (HLP) involving LDL or Lp(a) particles. Major therapeutic effect of LA is preventing cardiovascular events. Stabilizing plaque morphology might be an important underlying mechanism of action. In Germany, since 2008, a reimbursement guideline has been implemented to establish the indication for LA not only for familial or severe forms of hypercholesterolemia but also for Lp(a)-HLP associated with a progressive course of cardiovascular disease, that persists despite effective treatment of other concomitant cardiovascular risk factors, i.e. isolated Lp(a)-HLP. The Pro(a)LiFe-study confirmed with a prospective multicenter design that LA can effectively reduce Lp(a) plasma levels and prevent cardiovascular events.
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Klingel et al. (2015) conducted an observational in Lp(a)-hyperlipoproteinemia and progressive cardiovascular disease (n=170). Lipoprotein apheresis vs. Retrospective period before commencing therapy was evaluated on Major adverse cardiac events (MACE) (NNT 3). Lipoprotein apheresis lowered Lp(a) plasma levels by 74% and reduced major adverse cardiac events from 142 to 31 over two years, yielding a number needed to treat of 3.
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