Lipoprotein Apheresis vs. Sham in Patients With Refractory Angina and High Lp(a)

Lipoprotein apheresis resulted in significant improvements compared to sham therapy in patients with refractory angina along with raised levels of lipoprotein (Lp)(a), according to new research presented Aug. 29 at ESC Congress 2016 in Rome.

The study randomized 20 patients with refractory angina and elevated Lp(a) levels above 500mg/L to weekly lipoprotein apheresis or sham treatments for three months and then crossed over for another three months, with a one-month washout period in-between. The primary outcome, measured with cardiac magnetic resonance imaging, was myocardial perfusion reserve (MPR).

Results showed a significant increase of 0.63 in MPR after apheresis treatment compared to sham (P<0.001).  Specifically, MPR increased from 1.45 to 1.93 with apheresis, but did not change significantly after sham. Secondary endpoints of carotid wall volume and distensibility were also improved after apheresis but not sham, as were exercise capacity, symptoms of angina, and quality of life scores, according to lead investigator Tina Khan, MRCP, from Royal Brompton and Harefield NHS Trust and Imperial College, London.

“Our trial provides the first evidence that lipoprotein apheresis leads to improvement among these patients in the primary endpoint of myocardial blood flow,” said Khan. “These findings suggest that lipoprotein apheresis provides significant clinical benefit to patients with refractory angina in the context of raised Lp(a), representing a much needed novel treatment option for this therapeutically challenging patient cohort.”

“With such a small sample size the results must be viewed as preliminary,” cautions Kim A. Eagle, MD, MACC, editor in chief of

Clinical Topics: Dyslipidemia, Stable Ischemic Heart Disease, Advanced Lipid Testing, Lipid Metabolism, Nonstatins, Chronic Angina

Keywords: ESC Congress, Angina Pectoris, Blood Component Removal, Lipoprotein(a), Angina, Stable

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