Apheresis
Lipoprotein apheresis remains the only approved Lp(a)-specific option for peripheral artery disease patients with elevated Lp(a), review finds (Curr Opin Lipidol 2025)
Original title: Peripheral arterial disease associated with elevated lipoprotein(a): a review of the evidence and treatment approaches
This review by Bhatia, Dalal and Ross summarises evidence on Lp(a) in peripheral arterial disease (PAD), a disease with substantial morbidity, mortality and largely modifiable risk factors, yet persistently poor prognosis. Elevated Lp(a) is strongly supported as a causal, independent risk factor for PAD, associated with disease severity and higher risk of major adverse cardiovascular and limb events. PCSK9 inhibitors offer only modest Lp(a) reduction, and while several dedicated Lp(a)-lowering therapies are under investigation, prospective cohort studies have already reported clinical benefit, including reduced cardiovascular event risk, from lipoprotein apheresis in PAD patients with elevated Lp(a). The authors conclude that treatment options for these patients remain limited, with apheresis currently the only therapy specifically approved to lower Lp(a).
Original abstract
Purpose Of Review: Peripheral arterial disease (PAD) is an atherosclerotic and thrombotic disease associated with substantial morbidity and mortality. Although risk factors for PAD are mostly modifiable, prognosis remains poor, and patients are at a high risk of cardiovascular events. This review aims to summarize current evidence surrounding the role of lipoprotein(a) (Lp[a]) in PAD and examines the available data on lipoprotein apheresis as an effective management approach for patients with PAD with elevated Lp(a).
Recent Findings: Evidence strongly indicates that elevated Lp(a) is a causal and independent risk factor for PAD and is associated with PAD severity and increased risk of adverse outcomes, including major adverse cardiovascular events and major adverse limb events. Proprotein convertase subtilisin/kexin type 9 inhibitors can modestly reduce Lp(a) levels, and several Lp(a)-lowering therapies are currently under investigation. Prospective cohort studies in patients with PAD with elevated Lp(a) have reported clinical benefits of lipoprotein apheresis, including reduction of cardiovascular event risk.
Summary: Limited treatment options exist for patients with PAD and elevated Lp(a). Lipoprotein apheresis is currently the only treatment option approved specifically for lowering Lp(a) levels.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.