Lp(a): A Toolkit for Health Care Professionals

12 Recent Approaches to Lowering Lp(a): What the Studies Show 14 z According to the Lipoprotein Apheresis study by Moriarty, Gray and Gorby, lipoprotein apheresis should be considered for patients in the United States suffering from an elevated Lp(a) and progressive CVD. Moriarty and colleagues report that LA therapy has demonstrated a reduction of LDL cholesterol and Lp(a) as well as a significant reduction in future CVD events. In their study of patients with near normal LDL-C and elevated Lp(a) they report a percent reduction of 64% and 63% for LDL-C and Lp(a), respectively, with a mean LDL-C to 29 mg/ dL and Lp(a) to 51 mg/dL, with a 94% reduction in major adverse cardiovascular events over a mean treatment period of 48 months. 23 z In the Pro(a)LiFe-Study, Lipoprotein Apheresis for Lipoprotein(a)- Associated Cardiovascular Disease: Prospective 5 Years of Follow-Up and Apolipoprotein(a) Characterization, results confirm that LA has a lasting effect on prevention of cardiovascular events in patients with Lp(a)- hyperlipidemia. Patients clinically selected by progressive cardiovascular disease were characterized by a highly frequent expression of small apo(a) isoforms. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein cholesterol and Lp(a) were 2.56±1.04 mmol·L(-1) (99.0±40.1 mg·dL(-1)) and Lp(a) 3.74±1.63 µmol·L(-1) (104.9±45.7 mg·dL(-1)), respectively. Mean annual rates for Major Adverse Coronary Events (MACE) declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA (P<0.0001 and Number Need to Treat (NNT) was 3 after 2 years. Event rates including all vascular beds declined from 0.61 to 0.16 (P<0.0001). Analysis of single