Optimizing Use and Clinical Considerations for Lipoprotein Apheresis, with Laurence Sperling, MD, and Eugenia Gianos, MD

Despite offering the potential to improve outcomes in certain patients with familial hypercholesterolemia (FH) and being the only therapeutic approach currently approved by the US Food and Drug Administration for lowering lipoprotein(a) [Lp(a)], lipoprotein apheresis goes underutilized in contemporary settings, according to a new scientific statement from the American Heart Association (AHA).

In recent years, a growing body of evidence has outlined the potential of this therapeutic approach, with this growth culminating in the release of the latest scientific statement from the AHA. Released on October 07, 2024 and titled “Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association,”, the document reviews the historical development, available devices, indications, efficacy, vascular effects, outcomes data, use in special populations, availability, access, cost, and patient perspectives on lipoprotein apheresis.

In recognition of the efforts of the AHA and the volunteer writing committee, HCPLive has launched the latest Special Report series spotlighting the scientific statement with writing committee chair Laurence Sperling, MD, Katz Professor in Preventive Cardiology and founder of the Emory Center for Heart Disease Prevention, and vice chair Eugenia Gianos, MD, director of Cardiovascular Prevention at Northwell Health.

In this segment, which is part 2 of our 3-part series, Sperling and Gianos discuss the benefits and challenges of lipoprotein apheresis as a treatment for patients with severe lipid disorders, particularly those with homozygous familial hypercholesterolemia and elevated Lp(a). Sperling, who helped establish Emory’s lipoprotein apheresis program, highlights how this procedure provides life-saving options for patients with genetic lipid conditions, especially those who do not respond to standard therapies due to non-functional LDL receptors.

Gianos delves into the clinical evidence supporting lipoprotein apheresis, noting that while randomized controlled trials are limited, observational data show significant cardiovascular event reductions, with some studies reporting up to a 95% decrease in events. They also discuss the unique ability of apheresis to not only lower LDL cholesterol but also reduce inflammation and improve endothelial function, which contributes to vascular healing.

The conversation touches on underexplored areas, such as the potential for using apheresis in patients with focal segmental glomerulosclerosis and other challenging populations, including stroke patients and pediatric cases. Both experts emphasize the need for further research and collaboration with nephrologists and other specialists to expand the use of this therapy for broader patient groups.

Check out more from this series:

Introduction

Clinical Application of Lipoprotein Apheresis

Future Considerations

Laurence Sperling has no disclosures to report. Relevant disclosures for Gianos include Amgen, AstraZeneca,Eli Lilly and Company, kaenka, Novartis, and Med-IQ.

References:

1. Gianos E, Duell PB, Toth PP, et al. Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. Published online October 7, 2024. doi:10.1161/ATV.0000000000000177
2. Iapoce C. AHA scientific statement promotes expanded use of lipoprotein apheresis. HCP Live. October 11, 2024. Accessed October 17, 2024. https://www.hcplive.com/view/aha-scientific-statement-promotes-expanded-use-of-lipoprotein-apheresis.