Lipoprotein Apheresis for Reduction of Lipoprotein(a)

Lipoprotein apheresis (LA) is currently (still) the most effective therapeutic approach to decrease the cardiovascular risk associated with high lipoprotein(a) [Lp(a)] concentrations. It is indicated in patients who developed cardiovascular events (CVEs), especially in those who show a progress of atherosclerosis despite a rather good compensation of all other risk factors [including LDL (low-density lipoprotein) cholesterol]. Several LA methods can be used; they all acutely reduce Lp(a) levels by more than 70%. The interval mean values are decreased by more than 50%, when compared with the Lp(a) concentration before the initiation of LA. Several observational and case control studies showed that an LA therapy leads to a lasting reduction of the incidence of CVEs by about 80–90% when taking into account the situation in the years before the start of LA. No randomized controlled study was performed, due to ethical concerns. In Germany, an LA registry exists. This review reports cases where the situation of arterial vessels was extremely critical; it shows certain limitations of the extracorporeal treatment. Finally, options to further improve the prognosis of patients (e.g., more LA sessions, adding PCSK9 inhibitors) and the future of LA therapy taking into consideration inhibitors of apolipoprotein(a) synthesis are discussed.