Therapeutic Apheresis for Management of Lp(a) Hyperlipoproteinemia.

Most clinical studies designed to treat Lp(a) hyperlipoproteinemia with different LA systems are small in size but demonstrate that the elimination of Lp(a) from bloodstream leads to reduction of inflammatory and prothrombotic process in a few months and to atherosclerotic plaques regression in 1.5 years. Treatment with LA for 2 to 5 years in terms of clinical trials and in real-world setting provides further evidence that Lp(a) reduction by 60-80% is associated with proportional decreasing of rate and risk of cardiovascular events. Specific Lp(a) apheresis is the only possible method that solely targets Lp(a). In most countries, non-specific LA is used for treatment Lp(a) hyperlipoproteinemia in very high-risk subjects with progressive ASCVD. PCSK9 inhibitors have only modest effect on significantly elevated Lp(a), whereas large population-based studies requested sustained and prolonged reduction of Lp(a) levels by 50-100 mg/dL to gain proportional decreasing of major adverse cardiovascular events.