Treatment of symptomatic HyperLp(a)lipoproteinemia with LDL-apheresis: a multicentre study

Stefanutti, C.; D'Alessandri, G.; Russi, G.; De Silvestro, G.; Zenti, M.G.; Marson, P.; Belotherkovsky, D.; Vivenzio, A.; Di Giacomo, S.

doi:10.1016/S1567-5688(09)71819-7

« Previous Next »Atherosclerosis Supplements
Volume 10, Issue 5 , Pages 89-94, 29 December 2009

Treatment of symptomatic HyperLp(a)lipoproteinemia with LDL-apheresis: a multicentre study

C. Stefanutti
- Dipartimento di Clinica e Terapia Medica, Plasmapheresis Unit, University of Rome “La Sapienza”, Policlinico “Umberto I”, Italy
- Department of Clinical and Medical Therapy. Plasmapheresis Unit. “La Sapienza”, University of Rome. “Umberto I” Hospital. 155, Viale del Policlinico I-00161 Rome, Italy. Phone: ++39 06 49970578
G. D'Alessandri
- UOC Immunoematologia e Trasfusionale, ASL 3, Pistoia, Italy
G. Russi
- UOC Medicina Trasfusionale e Immunoematologia “Arcispedale S. Maria Nuova”, Reggio Emilia, Italy
G. De Silvestro
- UOC Immunotrasfusionale – Az. Ospedaliera di Padova – University of Padova, Italy
M.G. Zenti
- Divisione di Endocrinologia e Malattie del Metabolismo, Azienda Ospedaliera-Universitaria di Verona, Italy
P. Marson
- UOC Immunotrasfusionale – Az. Ospedaliera di Padova – University of Padova, Italy
D. Belotherkovsky
- Dipartimento di Clinica e Terapia Medica, Plasmapheresis Unit, University of Rome “La Sapienza”, Policlinico “Umberto I”, Italy
A. Vivenzio
- Dipartimento di Clinica e Terapia Medica, Plasmapheresis Unit, University of Rome “La Sapienza”, Policlinico “Umberto I”, Italy
S. Di Giacomo
- Dipartimento di Clinica e Terapia Medica, Plasmapheresis Unit, University of Rome “La Sapienza”, Policlinico “Umberto I”, Italy

Abstract

LDL-apheresis (LDLa) efficacy in the treatment of symptomatic HyperLp(a)lipoproteinemia -HyperLp(a)- has been studied in a multicentre trial. After 3.1±2.7 years of weekly and biweekly treatment, the data from 19 patients (males:12; females:7; aged 53.8±9.3 years; mean body mass index: 24.6±2.3 Kg/m²) were evaluated. Data were collected using the same questionnaire shared by 5 participating centres. A total of 2331 procedures were performed. A mean of 3593.7±800.3 ml of plasma or 8115.3±2150.1 ml of blood, depending upon the technique used (H.E.L.P., D.A.LI., Dextransulphate, Lipocollect 200), was regularly treated on average every 10.1±2.6 days. Baseline mean Lp(a) levels were 172.3±153.8 mg/dL. The mean pre-/post-apheresis Lp(a) levels decreased from 124.5±107.2 mg/dL (p<0.001 vs baseline) to 34.2±40.6 mg/dL (p<0.001 vs pre-). Baseline mean LDL-cholesterol (LDLC) levels were 152.3±74.6 mg/dL. The mean pre-/post-apheresis LDLC levels decreased from 130.4±61.1 mg/dL (p<0.004 vs baseline) to 41.2±25.1 mg/dL (p<0.001 vs pre-). The hypolipidemic drugs given to the patients during LDLa were: ezetimibe+simvastatin, atorvastatin, rosuvastatin, pravastatin, acipimox, and ω-3 fatty acids. 58% of the patients had arterial hypertension. Cigarette smokers were 5.3%. Alcohol intake was present in 21%. 52.6% were physically active. Patients with coronary artery disease (CAD) submitted to coronary catheterization before LDLa were 95%. In 5.5% (#1) CAD recurred despite treatment with LDLa. 79% were submitted to coronary revascularization before LDLa. CAD was: monovasal in 8 patients (42.1%), bivasal in 5 (26.4%), trivasal in 4 (21%), plurivasal in 2 (10.5%). In 94.5% of the sample the lesions were stable (< 0% deviation) over 3.1±2.7 years. 37% had both CAD and extra-coronary artery disease. This multicentre study confirmed that long-term treatment with LDLa was at least able to stabilize CAD in the majority of the individuals with symptomatic HyperLp(a).

Keywords: HyperLp(a)lipoproteinemia , LDL-apheresis , Coronary artery disease , Multicentre study

No full text is available. To read the body of this article, please view the PDF online.