Apheresis
Chronic lipoprotein apheresis progresses aortic valve stenosis at a similar rate whether or not Lp(a) is elevated, 47-patient follow-up finds (Endocrine 2025)
Original title: Aortic valve stenosis in high-Lipoprotein(a) patients: the role of lipoprotein apheresis
This retrospective study followed 47 patients (mean age 52 ± 12 years, 72% male) on more than three years of chronic lipoprotein apheresis (LA), with echocardiographic follow-up, to assess how high Lp(a) (above 50 mg/dL, present in 30 of 47) affects aortic valve stenosis progression. At baseline, high-Lp(a) patients had more severe valve disease (mild-to-moderate disease in 7/30 vs. 0/17, P < 0.05). Over a median follow-up of 10 [5-14] years, aortic peak velocity rose overall (baseline 1.45 ± 0.42 m/sec vs. follow-up 1.78 ± 0.92 m/sec, P < 0.001), and the rate of progression in high-Lp(a) patients was comparable to that in patients with normal Lp(a); two patients with moderate baseline stenosis eventually required valve replacement, one after 15 years of LA therapy. The authors conclude LA remains a safe, effective long-term therapy that neutralises Lp(a)'s expected excess risk of valve disease progression, though many high-Lp(a) patients likely still go unidentified before disease develops.
Original abstract
BACKGROUND: Nowadays, despite the new lipid-lowering drugs, lipoprotein apheresis (LA) maintains its therapeutic role in severe hypercholesterolemia in subjects without achieved LDL-cholesterol target on maximally tolerated lipid-lowering therapies and in subjects with high levels of lipoprotein (a) (> 50 mg/dl). The coexistence of both familial hypercholesterolemia and elevated-Lp(a) increase the risk of cardiovascular events and are associate with aortic valve stenosis. OBJECTIVES: The aim of this study was to evaluate the progression of aortic valve disease in subjects of chronic LA treatment in relation to the presence of high levels of lipoprotein (a). METHODS: To evaluate the therapeutic role of LA in aortic valve stenosis progression related to high-lipoprotein (a), patients with more than 3 years of chronic LA therapy were retrospective evaluated: have been identified 47 patients (mean age 52 ± 12 years, male 72%) with suitable echocardiographic follow-up. RESULTS: Subjects with high-Lp(a) (30/47) had a more severe aortic valve disease at the beginning of LA treatment (mild/moderate aortic valve disease 7/30 vs. 0/17; p < 0.05). During the follow-up (10 [5-14] years) a progressive increase in aortic peak velocity (baseline 1.45 ± 0.42 m/sec vs. follow-up 1.78 ± 0.92 m/sec, p < 0.001) was recorded in overall subjects. Moreover, in subjects with high-Lp(a) the progression of aortic disease is similar to subjects with normal lipoprotein(a) values: Δ aortic peak velocity (m/sec) respectively 0.14 [0.30–0.55] vs. 0.20 [0.07–0.39]. Two patients with moderate baseline aortic stenosis required valve replacement, even after 15 years from the start of LA therapy. CONCLUSIONS: Even in the era of new lipid-lowering therapies, patients with high-Lp(a) may not be identified early and develop aortic valve disease. However, LA remains a safe and life-saving treatment with a comparable aortic valve stenosis progression regardless of the Lp(a) values.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.