Schatz U, Tselmin S, Müller G, Julius U, Hohenstein B, Fischer S, Bornstein S R
Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany.
Atheroscler Suppl. 2017 Nov;30:246-252. doi: 10.1016/j.atherosclerosissup.2017.05.047. Epub 2017 Jun 3.
Lipoprotein(a) (Lp(a)) is an independent cardiovascular (CV) risk factor, predisposing to premature and progressive CV events. Lipoproteinapheresis (LA) is the only efficacious therapy for reducing Lp(a). Data comparing the clinical efficacy of LA with respect to reduction of CV events in subjects with elevated Lp(a) versus LDL-C versus both disorders is scarce. We aimed to perform this comparison in a multicenter observational study.
113 LA patients from 8 apheresis centers were included (mean age 56.3 years). They were divided into 3 groups: Group I: Lp(a) < 600 mg/l, LDL-C > 2.6 mmol/l, Group II: Lp(a) > 600 mg/l, LDL-C < 2.6 mmol/l, and Group III: Lp(a) > 600 mg/l, LDL-C > 2.6 mmol/l. CV events were documented 2 years before versus 2 years after LA start.
Before start of LA Group II showed the highest CV event rate (p 0.001). Group III had a higher CV event rate than Group I (p 0.03). During LA there was a significant reduction of CV events/patient in all vessel beds (1.22 ± 1.16 versus 0.33 ± 0.75, p < 0.001). The highest CV event rate during LA was seen in coronaries followed by peripheral arteries, cerebrovascular events were least common. Greater CV event reduction rates were achieved in patients with isolated Lp(a) elevation (-77%, p < 0.001) and in patients with Lp(a) and LDL-C elevation (-74%, p < 0.001) than in subjects with isolated hypercholesterolemia (-53%, p 0.06).
This study demonstrates that patients with Lp(a) elevation benefit most from LA treatment. Prospective trials to confirm these data are warranted.
脂蛋白(a)[Lp(a)]是一种独立的心血管（CV）危险因素，易引发过早和进行性CV事件。脂蛋白分离术（LA）是降低Lp(a)的唯一有效疗法。关于LA在降低Lp(a)升高患者与低密度脂蛋白胆固醇（LDL-C）升高患者以及两种疾病均有的患者CV事件方面的临床疗效比较数据稀缺。我们旨在通过一项多中心观察性研究进行此项比较。
纳入来自8个血液分离中心的113例LA患者（平均年龄56.3岁）。他们被分为3组：第一组：Lp(a)<600mg/l，LDL-C>2.6mmol/l；第二组：Lp(a)>600mg/l，LDL-C<2.6mmol/l；第三组：Lp(a)>600mg/l，LDL-C>2.6mmol/l。记录LA开始前2年与开始后2年发生的CV事件。
在LA开始前，第二组的CV事件发生率最高（p=0.001）。第三组的CV事件发生率高于第一组（p=0.03）。在LA治疗期间，所有血管床的患者CV事件均显著减少（1.22±1.16对0.33±0.75，p<0.001）。LA治疗期间CV事件发生率最高的是冠状动脉，其次是外周动脉，脑血管事件最不常见。与单纯高胆固醇血症患者（-53%，p=0.06）相比，单纯Lp(a)升高患者（-77%，p<0.001）和Lp(a)与LDL-C均升高患者（-74%，p<0.001）的CV事件减少率更高。
本研究表明，Lp(a)升高的患者从LA治疗中获益最大。有必要进行前瞻性试验以证实这些数据。
