THERAPEUTIC EFFICIENCY OF LIPOPROTEIN(A) REDUCTION BY LOW-DENSITY-LIPOPROTEIN IMMUNOAPHERESIS

This study was performed to investigate the effect of low-density lipo protein (LDL) immunoapheresis on lipoprotein(a) [Lp(a)] reduction in p atients with heterozygous and homozygous familial hyperlipidemia (N = 16) and insufficient response to lipid-lowering agents, By desorption of approximately 5,700 +/- 500 mL of plasma, a mean reduction in total cholesterol of 62% (P < .001) and in LDL-cholesterol of 70% (P < .001 ) was achieved. Lp(a), which was elevated at study entry in seven of t hese patients (82.1 +/- 34.3 mg/dL; range, 48 to 148 mg/dL), was reduc ed during the initial LDL-apheresis procedure by 74.8% +/- 14.1% (P < .001), Long-term apheresis treatment performed at weekly intervals res ulted in an mean reduction in Lp(a) pretreatment values to 39.1 +/- 28 .5 mg/dL (-54%; P < .001). Desorbed Lp(a) was measured at the waste of the columns for 31 apheresis treatments. Lp(a) concentration of the c olumn waste was higher in patients with elevated serum Lp(a) pretreatm ent values as compared with those with Lp(a) serum values within the n ormal range (elevated Lp(a), 1,420 +/- 380 mg; without elevated Lp(a), 235 +/- 190 mg; P < .001), The rate of return of Lp(a) following aphe resis treatment scheduled at weekly intervals was comparable to that o f LDL-cholesterol. Copyright (C) 1998 by W.B. Saunders Company.