Apheresis
Lipoprotein apheresis cuts major cardiovascular events by 94% in US patients with high Lp(a) and normal LDL, a retrospective cohort of 14 patients (J Clin Lipidol 2019)
Original title: Lipoprotein apheresis for lipoprotein(a) and cardiovascular disease
This retrospective cohort study at a single US lipoprotein apheresis (LA) site evaluated 14 cardiovascular disease patients with elevated Lp(a) and near-normal LDL cholesterol, a population for whom LA is not currently approved in the United States (unlike Germany, which approves LA for Lp(a) above 60 mg/dL with normal LDL and demonstrated over 70% reduction in cardiovascular events). Before LA, mean LDL cholesterol was 80 mg/dL and Lp(a) was 138 mg/dL; LA reduced mean LDL cholesterol to 29 mg/dL (a 64% reduction) and Lp(a) to 51 mg/dL (a 63% reduction). Over a mean 48-month treatment period, major adverse cardiovascular events fell by 94%. The findings support considering LA for US patients with elevated Lp(a) and progressive cardiovascular disease despite near-normal LDL cholesterol, a population currently excluded from LA eligibility in the United States.
Original abstract
Background: Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD). In the United States, lipoprotein apheresis (LA) therapy is approved for patients with familial hypercholesterolemia. Germany uses LA therapy for patients with an Lp(a) > 60 mg/dL, normal low-density lipoprotein cholesterol (LDL-C) levels, and CVD. LA therapy in this population demonstrated a >70% reduction in CVD events. In the United States, LA is only approved for patients with elevated LDL-C levels, regardless of Lp(a) level.
Objective: The objective of the study was to evaluate clinical significance of Lp(a) reduction with LA therapy in the United States.
Methods: A retrospective cohort study at one LA site in the United States evaluated 14 CVD patients with elevated Lp(a) and near normal LDL-C levels. Patient data was analyzed to demonstrate possible clinical benefit in reducing Lp(a) levels with LA to mitigate risk of major adverse cardiovascular events.
Results: Pre-LA patients' mean LDL-C and Lp(a) were 80 mg/dL and 138 mg/dL, respectively. LA therapy demonstrated a reduction of mean LDL-C to 29 mg/dL and Lp(a) to 51 mg/dL. These represent a percent reduction of 64% and 63% for LDL-C and Lp(a), respectively. There was a 94% reduction in major adverse cardiovascular events over a mean treatment period of 48 months.
Conclusion: The treatment of CVD patients with an elevated Lp(a) and near normal LDL-C with LA in a U.S. treatment center demonstrated a significant reduction in future CVD events. LA should be considered for patients in the United States suffering from an elevated Lp(a) and progressive CVD.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.