Jaeger Beate R, Richter Yvonne, Nagel Dorothea, Heigl Franz, Vogt Anja, Roeseler Eberhard, Parhofer Klaus, Ramlow Wolfgang, Koch Michael, Utermann Gerd, Labarrere Carlos A, Seidel Dietrich
Labor Dr Stein und Kollegen, Medizinisches Versorgungszentrum Laboratoriumsmedizin, Mikrobiologie, Infektionsepidemiologie, Virologie, Transfusionsmedizin und Humangenetik, Mönchengladbach, Germany.
Nat Clin Pract Cardiovasc Med. 2009 Mar;6(3):229-39. doi: 10.1038/ncpcardio1456.
We investigated in a longitudinal, multicenter, cohort study whether combined lipid apheresis and lipid-lowering medication can reduce extremely high levels of lipoprotein(a) (Lp[a]) and thus prevent major adverse coronary events (MACE) more efficaciously than lipid-lowering medication alone.
Eligible patients had coronary artery disease and Lp(a) levels > or =2.14 micromol/l (95th percentile). All patients received lipid-lowering medications alone until maximally tolerated doses were no longer effective, followed by combined lipid apheresis and lipid-lowering medication. The rates of the primary outcome, MACE, were recorded for both periods.
A total of 120 patients were included. The mean duration of lipid-lowering therapy alone was 5.6+/-5.8 years, and that of apheresis was 5.0+/-3.6 years. Median Lp(a) concentration was reduced from 4.00 micromol/l to 1.07 micromol/l with apheresis treatment (P<0.0001); the corresponding mean annual MACE rate per patient was 1.056 versus 0.144 (P<0.0001).
Lowering of Lp(a) levels by apheresis was efficacious and safe, and we recommend this therapy for patients in whom maximally tolerated doses of medication alone have failed to control coronary artery disease-associated events.
我们在一项纵向、多中心队列研究中调查了联合血脂分离术和降脂药物治疗是否比单纯降脂药物更有效地降低极高水平的脂蛋白(a)[Lp(a)]，从而预防主要不良冠状动脉事件(MACE)。
符合条件的患者患有冠状动脉疾病且Lp(a)水平≥2.14微摩尔/升（第95百分位数）。所有患者先单独接受降脂药物治疗，直至最大耐受剂量不再有效，随后接受血脂分离术联合降脂药物治疗。记录两个阶段的主要结局MACE发生率。
共纳入120例患者。单纯降脂治疗的平均持续时间为5.6±5.8年，血脂分离术的平均持续时间为5.0±3.6年。血脂分离术治疗后，Lp(a)浓度中位数从4.00微摩尔/升降至1.07微摩尔/升（P<0.0001）；相应的每位患者每年MACE平均发生率分别为1.056和0.144（P<0.0001）。
通过血脂分离术降低Lp(a)水平是有效且安全的，对于单独使用最大耐受剂量药物未能控制冠状动脉疾病相关事件的患者，我们推荐这种治疗方法。
