Detailed description of the cardiovascular situation in patients who have started lipoprotein apheresis treatment.

Background: Lipoprotein apheresis (LA) therapy is effective in eliminating atherogenic lipoproteins and reducing the rate of cardiovascular events (CVE) in patients suffering from severe hypercholesterolemia or increased lipoprotein(a) (Lp(a)) levels despite maximal tolerated lipid lowering therapy.
Methods: We examined the rate of CVE in 116 patients (63% males) with an isolated increase of LDL-cholesterol (LDL-C) (Group 1), an isolated increase of Lp(a) (Group 2), a combined increase of LDL-C and Lp(a) (Group 3) and patients who were referred for LA, but never started (Group 4).
Results: Patients with increased Lp(a) (Groups 2 and 3) showed a higher prevalence of advanced atherosclerotic changes, defined as involvement of 3 or 4 vascular territories, including the abdominal aorta and leg arteries, and an involvement of more coronary vessels compared to patients in group 1. Prior to initiation of LA, on average patients suffered 4.4 (range: 0-14) CVE during a period of 7.2 (range: 0-41) years. Group 1 patients suffered fewer CVE per patient-year compared to the other groups (Group 1: 0.75, Group 2: 1.7, Groups 3 and 4: 1.4). 55-63% of patients applying for LA experienced a CVE within the last year (on average 1.3 CVE per patient in the last year). Among patients referred to LA there is a high rate of intolerance to nicotinic acid (42% of patients in Group 3) and statins (58% of patients in Group 1).
Conclusion: Patients referred to LA represent a high risk population for CVE in all vascular territories. Increased Lp(a) levels cause a higher percentage of patients with advanced atherosclerosis.
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