Current News
Lipoprotein (a) is a low-density lipoprotein (LDL) structure-like lipoprotein.
Its height is inherited, does not change significantly the whole life and can not be influenced by diet or medicaments.
A one-time determination is therefore sufficient.
If the lipoprotein (a) is increased to more than 100 mg / dl, life expectancy is shortened by about 10 years. Therapy of choice is on the one hand a particularly pronounced one LDL reduction or – in individual cases – LDL apheresis.
Lp-Apheresis or. PCSK9 – Inhibitors
The therapy of fat metabolism is always a step therapy.
Firstly, an assessment of nutritional and lifestyle habits as well as a consultation on necessary changes is appropriate. If these measures are not sufficient, a therapy is started with lipid-lowering medications (usually from the family of statins). If this is not sufficient too, a combination with other lipid nuclei can lead to a further improvement in the blood fat values.
If the drug combination therapy is not sufficient or if these side effects occur, a PCSK9 inhibitor therapy is indicated.
Therapy with PCSK9-Inhibitors |
| • monoclonal antibodies against PCSK9 (Evolocumab, Alirocumab) • each subcutaneously |
Metabolic Control |
| • under a lipid-lowering therapy (usually statins) together with PCSK9 inhibitors an approx. 50-60% additional reduction of LDL-C is achieved • Reduction of the lipoprotein (a) (Lp [a]) by approx. 25% • Reduction of triglycerides by 12-17% |
Reduction of cardiovascular events |
| • First results (post-hoc analyzes for evolocumab and alirocumab) show an approx. 50% reduction in cardiovascular events. • Final evaluation possible only after publication of the large clinical endpoint studies (expected in 2017). |
Side effects |
| • with the exception of muscle complaints, are not significantly different from the control groups • local reaction at the injection site (up to 6% of the affected population) • Upper respiratory infections (up to 5%) • flu-like symptoms (up to 3%) • muscle complaints (up to 5 %) |
Lp-Apheresis Therapie
However, if the lipoprotein (a) is elevated above the corresponding limit of 100 mg / dl, either isolated or in combination with the increase in other blood fats, only liporprotein apheresis is a measure assured by studies.
Primary prevention |
| • Homozygote FH (Start of treatment in childhood) • Heterozygote FH, despite maximum drug combination therapy LDL-C > 190 mg/dl |
Cardiovascular (first) event – secondary prevention |
| • Lp(a) > 100 mg/dl (>~ 250 nmol/L), At first, LDL-C should be reduced by LDL-C <70mg / dL by means of drug combination therapy, if necessary, additional PCSK9 inhibitors. In case of therapy failure, LP-apheresis. • In the case of progressive atherosclerosis, LDL-C <70 mg / dl and / or non-HDL-C <100 mg / dl and / or non-HDL-Lp <130 mg / dl and / or increased Lp(a) > 100 mg/dl (>~ 250 nmol/L) • Documented intolerance of all available statins, LDL-C treatment target is not achieved and Lp (a) > 100mg/dl (>~ 250 nmol/L) |