Aortic valve stenosis in high-Lipoprotein(a) patients: the role of lipoprotein apheresis.

BACKGROUND

Nowadays, despite the new lipid-lowering drugs, lipoprotein apheresis (LA) maintains its therapeutic role in severe hypercholesterolemia in subjects without achieved LDL-cholesterol target on maximally tolerated lipid-lowering therapies and in subjects with high levels of lipoprotein (a) (> 50 mg/dl). The coexistence of both familial hypercholesterolemia and elevated-Lp(a) increase the risk of cardiovascular events and are associate with aortic valve stenosis.

OBJECTIVES

The aim of this study was to evaluate the progression of aortic valve disease in subjects of chronic LA treatment in relation to the presence of high levels of lipoprotein (a).

METHODS

To evaluate the therapeutic role of LA in aortic valve stenosis progression related to high-lipoprotein (a), patients with more than 3 years of chronic LA therapy were retrospective evaluated: have been identified 47 patients (mean age 52 ± 12 years, male 72%) with suitable echocardiographic follow-up.

RESULTS

Subjects with high-Lp(a) (30/47) had a more severe aortic valve disease at the beginning of LA treatment (mild/moderate aortic valve disease 7/30 vs. 0/17; p < 0.05). During the follow-up (10 [5-14] years) a progressive increase in aortic peak velocity (baseline 1.45 ± 0.42 m/sec vs. follow-up 1.78 ± 0.92 m/sec, p < 0.001) was recorded in overall subjects. Moreover, in subjects with high-Lp(a) the progression of aortic disease is similar to subjects with normal lipoprotein(a) values: Δ aortic peak velocity (m/sec) respectively 0.14 [0.30–0.55] vs. 0.20 [0.07–0.39]. Two patients with moderate baseline aortic stenosis required valve replacement, even after 15 years from the start of LA therapy.

CONCLUSIONS

Even in the era of new lipid-lowering therapies, patients with high-Lp(a) may not be identified early and develop aortic valve disease. However, LA remains a safe and life-saving treatment with a comparable aortic valve stenosis progression regardless of the Lp(a) values.