Lipoprotein apheresis to treat elevated lipoprotein (a)1

An elevated plasma concentration of lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease. Life style modification and currently available drugs either fail to effectively lower plasma Lp(a) levels or do not result in clinical benefit. However, lipoprotein apheresis is very efficient in decreasing Lp(a) concentrations. A single apheresis session can acutely decrease Lp(a) by approximately 60–75%, and apheresis performed weekly or biweekly results in considerably decreased mean interval concentrations (approximately 25–40% reduction). While most apheresis systems (heparin-induced extracorporeal LDL precipitation, direct adsorption of lipoproteins, lipoprotein apheresis with dextran-sulfate, lipid filtration, immunoadsorption) decrease LDL and Lp(a), Lipopac is specific and only decreases Lp(a). Lp(a) apheresis is expensive and time consuming, but associated with very few side effects. Two randomized controlled trials give conflicting consults with respect to the effect on angiographic changes. Retrospective analyses indicate that regular apheresis translates into clinical benefit in patients with elevated Lp(a), but adequate randomized controlled trials are lacking.