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Klaus G Parhofer - One of the best experts on this subject based on the ideXlab platform.

Andreas Heibges - One of the best experts on this subject based on the ideXlab platform.

  • lipoprotein apheresis for lp a Hyperlipoproteinemia with progressive cardiovascular disease additional particular aspects of the pro a life multicenter trial
    Atherosclerosis Supplements, 2015
    Co-Authors: Reinhard Klingel, Andreas Heibges, Cordula Fassbender
    Abstract:

    Lipoprotein apheresis (LA) can lower LDL-cholesterol and Lp(a) by 60%-70% and is the final escalating option in patients with Hyperlipoproteinemias involving LDL or Lp(a) particles. Major therapeutic effect of LA is preventing cardiovascular events. In Germany since 2008 a reimbursement guideline has been implemented accepting to establish the indication for LA not only for familial or severe forms of hypercholesterolemia but also based on Lp(a)-Hyperlipoproteinemia associated with a progressive course of cardiovascular disease, that persists despite effective treatment of other concomitant cardiovascular risk factors. The Pro(a)LiFe-study confirmed with a prospective multicenter design that LA can be regarded as an important therapeutic approach to effectively reduce Lp(a) plasma levels and prevent cardiovascular events in this particular high-risk patient group. Results support that Lp(a) may be a major causal factor for precipitating mechanisms of accelerated progression of cardiovascular disease (CVD). Indication for LA based on measurement of Lp(a) as part of risk assessment is supported by the following conditions: progressive CVD as assessed clinically and with imaging techniques, established maximally tolerated lipid lowering drug treatment, recent cardiovascular events despite efficient drug treatment, out of the ordinary frequency of cardiovascular events, early CVD, or positive family history of early CVD. Still existing difficulties with Lp(a) laboratory measurement require a practical approach to establish the indication for LA considering the 60 mg/dl threshold of German guidelines with selecting an Lp(a) assay which has been calibrated for mass.

  • lipoprotein apheresis in patients with maximally tolerated lipid lowering therapy lipoprotein a Hyperlipoproteinemia and progressive cardiovascular disease prospective observational multicenter study
    Circulation, 2013
    Co-Authors: Josef Leebmann, U Julius, Eberhard Roeseler, Franz Heigl, Ralf Spitthoever, Dennis Heutling, Paul Breitenberger, Winfried Maerz, Walter Lehmacher, Andreas Heibges
    Abstract:

    BACKGROUND: Lipoprotein(a) (Lp(a)) Hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. METHODS AND RESULTS: In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-Hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein cholesterol and Lp(a) were 2.56±1.04 mmol·L(-1) (99.0±40.1 mg·dL(-1)) and Lp(a) 3.74±1.63 µmol·L(-1) (104.9±45.7 mg·dL(-1)), respectively. Mean annual rates for major adverse coronary events declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA (P<0.0001). Event rates including all vascular beds declined from 0.61 to 0.16 (P<0.0001). Analysis of single years revealed increasing major adverse coronary event rates from 0.30 to 0.54 (P=0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 (P<0.0001) and to 0.05 from y+1 to y+2 (P=0.014). CONCLUSIONS: In patients with Lp(a)-Hyperlipoproteinemia, progressive cardiovascular disease, and maximally tolerated lipid-lowering medication, LA effectively lowered the incidence rate of cardiovascular events. CLINICAL TRIAL REGISTRATION URL: https://drks-neu.uniklinik-freiburg.de. Unique identifier: DRKS00003119.

  • lipoprotein apheresis in patients with maximally tolerated lipid lowering therapy lipoprotein a Hyperlipoproteinemia and progressive cardiovascular disease prospective observational multicenter study
    Circulation, 2013
    Co-Authors: Josef Leebmann, U Julius, Eberhard Roeseler, Franz Heigl, Ralf Spitthoever, Dennis Heutling, Paul Breitenberger, Winfried Maerz, Walter Lehmacher, Andreas Heibges
    Abstract:

    Background— Lipoprotein(a) (Lp(a)) Hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. Methods and Results— In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-Hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein cholesterol and Lp(a) were 2.56±1.04 mmol·L−1 (99.0±40.1 mg·dL−1) and Lp(a) 3.74±1.63 µmol·L−1 (104.9±45.7 mg·dL−1), respectively. Mean annual rates for major adverse coronary events declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA ( P <0.0001). Event rates including all vascular beds declined from 0.61 to 0.16 ( P <0.0001). Analysis of single years revealed increasing major adverse coronary event rates from 0.30 to 0.54 ( P =0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 ( P <0.0001) and to 0.05 from y+1 to y+2 ( P =0.014). Conclusions— In patients with Lp(a)-Hyperlipoproteinemia, progressive cardiovascular disease, and maximally tolerated lipid-lowering medication, LA effectively lowered the incidence rate of cardiovascular events. Clinical Trial Registration— URL: . Unique identifier: DRKS00003119. # Clinical Perspective {#article-title-17}

  • lipoprotein apheresis in patients with maximally tolerated lipid lowering therapy lipoprotein a Hyperlipoproteinemia and progressive cardiovascular disease
    Circulation, 2013
    Co-Authors: Josef Leebmann, U Julius, Eberhard Roeseler, Franz Heigl, Ralf Spitthoever, Dennis Heutling, Paul Breitenberger, Winfried Maerz, Walter Lehmacher, Andreas Heibges
    Abstract:

    Background—Lipoprotein(a) (Lp(a)) Hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. Methods and Results—In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-Hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein chol...

Klaus Empen - One of the best experts on this subject based on the ideXlab platform.

Jau-tsuen Kao - One of the best experts on this subject based on the ideXlab platform.

  • lipoprotein glomerulopathy associated with psoriasis vulgaris report of 2 cases with apolipoprotein e3 3
    American Journal of Kidney Diseases, 2003
    Co-Authors: Chao-fu Chang, Ming-shi Shiao, Chih-ching Lin, Jinn-yang Chen, An-hang Yang, Jau-tsuen Kao, Wu-chang Yang
    Abstract:

    Lipoprotein glomerulopathy (LPG) is a rare disease, characterized by a special histology, including dilated glomerular capillaries filled with pale-stained and meshlike lipoprotein thrombi. It always presents with proteinuria or nephrotic syndrome. Although hyperlipidemia is not always seen, most patients have type III Hyperlipoproteinemia with apolipoprotein (apo) E2/3 phenotyping. Although the clinical feature of LPG is rarely described, LPG associated with other glomerulopathy, including IgA nephropathy, membranous nephropathy, and lupus nephritis, has been documented. Until now, there have been no reports of psoriasis vulgaris associated with LPG. The authors present 2 cases of LPG with apo E3/3 genotyping associated with psoriasis vulgaris. The first patient was a 65-year-old woman who presented with nephrotic syndrome with daily urinary protein loss of 9.05 g and itchy erythematous scaly plaques on her trunk and lower limbs for 1 year. The renal biopsy results showed LPG, and the skin biopsy results showed psoriasis. The second patient was a 50-year-old man with history of psoriasis over his trunk and 4 limbs for 30 years. He also presented with nephrotic syndrome with daily urinary protein loss of 7.55 g. The renal biopsy results also showed LPG. The genotype of apo E showed E3/3, and lipoprotein electrophoresis showed a type III Hyperlipoproteinemia-like pattern in both cases. The authors suggest that presence of apo E3/3 genotype cannot rule out the diagnosis of type III Hyperlipoproteinemia and LPG. Besides, LPG should be included in the differential diagnosis of psoriatic patients with nephrotic syndrome, especially in Asian patients who show poor response to traditional therapy. Renal biopsy should be performed to make the definitive diagnosis.

  • apolipoprotein e2 3 genotype and type iii Hyperlipoproteinemia among taiwanese
    Clinica Chimica Acta, 2003
    Co-Authors: Hsingpei Lin, Jau-tsuen Kao
    Abstract:

    Background: Type III Hyperlipoproteinemia (HLP) is a genetic disorder of lipid metabolism in humans that predisposes affected subjects to the premature development of atherosclerosis. Most type III HLP occurs in homozygous carriers of apolipoprotein (apo) E2. The aims of this study were to determine the frequencies of different apo E genotypes in type III HLP in Taiwanese and to assess the possibility of apo E mutants in these patients. Materials and methods: Four hundred and seven patients with Hyperlipoproteinemia were recruited. Electrophoresis, apo E genotyping and sequencing were performed. Results: Of the 407 Hyperlipoproteinemia, 8 were identified as type III HLP. In contrast to reports of high apo e2/2 genotype prevalence, only two of the type III HLP subjects were of the apo e2/2 genotype (25%). Fifty percent of the type III HLP were of apo e2/3 genotype. This observation was further reflected in a lower frequency of the e2 allele (0.563) and higher e3 allele (0.375) frequency. No rare apo E variant was found by direct sequencing. Conclusion: The most common genotype of type III HLP in Taiwan was apo e2/3 instead of apo e2/2.

  • Lipoprotein glomerulopathy associated with psoriasis vulgaris: report of 2 cases with apolipoprotein E3/3.
    American journal of kidney diseases : the official journal of the National Kidney Foundation, 2003
    Co-Authors: Chao-fu Chang, Ming-shi Shiao, Chih-ching Lin, Jinn-yang Chen, An-hang Yang, Jau-tsuen Kao, Wu-chang Yang
    Abstract:

    Lipoprotein glomerulopathy (LPG) is a rare disease, characterized by a special histology, including dilated glomerular capillaries filled with pale-stained and meshlike lipoprotein thrombi. It always presents with proteinuria or nephrotic syndrome. Although hyperlipidemia is not always seen, most patients have type III Hyperlipoproteinemia with apolipoprotein (apo) E2/3 phenotyping. Although the clinical feature of LPG is rarely described, LPG associated with other glomerulopathy, including IgA nephropathy, membranous nephropathy, and lupus nephritis, has been documented. Until now, there have been no reports of psoriasis vulgaris associated with LPG. The authors present 2 cases of LPG with apo E3/3 genotyping associated with psoriasis vulgaris. The first patient was a 65-year-old woman who presented with nephrotic syndrome with daily urinary protein loss of 9.05 g and itchy erythematous scaly plaques on her trunk and lower limbs for 1 year. The renal biopsy results showed LPG, and the skin biopsy results showed psoriasis. The second patient was a 50-year-old man with history of psoriasis over his trunk and 4 limbs for 30 years. He also presented with nephrotic syndrome with daily urinary protein loss of 7.55 g. The renal biopsy results also showed LPG. The genotype of apo E showed E3/3, and lipoprotein electrophoresis showed a type III Hyperlipoproteinemia-like pattern in both cases. The authors suggest that presence of apo E3/3 genotype cannot rule out the diagnosis of type III Hyperlipoproteinemia and LPG. Besides, LPG should be included in the differential diagnosis of psoriatic patients with nephrotic syndrome, especially in Asian patients who show poor response to traditional therapy. Renal biopsy should be performed to make the definitive diagnosis.

U Julius - One of the best experts on this subject based on the ideXlab platform.

  • lipoprotein apheresis in patients with maximally tolerated lipid lowering therapy lipoprotein a Hyperlipoproteinemia and progressive cardiovascular disease prospective observational multicenter study
    Circulation, 2013
    Co-Authors: Josef Leebmann, U Julius, Eberhard Roeseler, Franz Heigl, Ralf Spitthoever, Dennis Heutling, Paul Breitenberger, Winfried Maerz, Walter Lehmacher, Andreas Heibges
    Abstract:

    BACKGROUND: Lipoprotein(a) (Lp(a)) Hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. METHODS AND RESULTS: In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-Hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein cholesterol and Lp(a) were 2.56±1.04 mmol·L(-1) (99.0±40.1 mg·dL(-1)) and Lp(a) 3.74±1.63 µmol·L(-1) (104.9±45.7 mg·dL(-1)), respectively. Mean annual rates for major adverse coronary events declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA (P<0.0001). Event rates including all vascular beds declined from 0.61 to 0.16 (P<0.0001). Analysis of single years revealed increasing major adverse coronary event rates from 0.30 to 0.54 (P=0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 (P<0.0001) and to 0.05 from y+1 to y+2 (P=0.014). CONCLUSIONS: In patients with Lp(a)-Hyperlipoproteinemia, progressive cardiovascular disease, and maximally tolerated lipid-lowering medication, LA effectively lowered the incidence rate of cardiovascular events. CLINICAL TRIAL REGISTRATION URL: https://drks-neu.uniklinik-freiburg.de. Unique identifier: DRKS00003119.

  • lipoprotein apheresis in patients with maximally tolerated lipid lowering therapy lipoprotein a Hyperlipoproteinemia and progressive cardiovascular disease prospective observational multicenter study
    Circulation, 2013
    Co-Authors: Josef Leebmann, U Julius, Eberhard Roeseler, Franz Heigl, Ralf Spitthoever, Dennis Heutling, Paul Breitenberger, Winfried Maerz, Walter Lehmacher, Andreas Heibges
    Abstract:

    Background— Lipoprotein(a) (Lp(a)) Hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. Methods and Results— In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-Hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein cholesterol and Lp(a) were 2.56±1.04 mmol·L−1 (99.0±40.1 mg·dL−1) and Lp(a) 3.74±1.63 µmol·L−1 (104.9±45.7 mg·dL−1), respectively. Mean annual rates for major adverse coronary events declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA ( P <0.0001). Event rates including all vascular beds declined from 0.61 to 0.16 ( P <0.0001). Analysis of single years revealed increasing major adverse coronary event rates from 0.30 to 0.54 ( P =0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 ( P <0.0001) and to 0.05 from y+1 to y+2 ( P =0.014). Conclusions— In patients with Lp(a)-Hyperlipoproteinemia, progressive cardiovascular disease, and maximally tolerated lipid-lowering medication, LA effectively lowered the incidence rate of cardiovascular events. Clinical Trial Registration— URL: . Unique identifier: DRKS00003119. # Clinical Perspective {#article-title-17}

  • current standards in diagnosis and therapy of Hyperlipoproteinemia
    Atherosclerosis Supplements, 2013
    Co-Authors: S Fischer, Ulrike Schatz, U Julius
    Abstract:

    Raised lipid parameters, especially increased LDL-cholesterol and lipoprotein(a) (Lp(a)) levels, are severe risk factors for atherosclerosis. Targets in the therapy of Hyperlipoproteinemia are dependent on other risk factors including diabetes mellitus and manifest cardiovascular disease. Fasting levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides are measured for diagnosis of this disease. Lp(a) should be evaluated in instances of positive family history for cardiovascular disease and/or severe progress of cardiovascular disease or premature cardiovascular events. The basis of therapy includes diet measures as well as weight reduction and lifestyle modifications (raised physical activity after excluding contraindications). Numerous patients require lipid-lowering drug therapy, including most importantly statins but also bile acid sequestrants, ezetimibe, fibrates, nicotinic acid or omega-3-fatty acids. Special forms of Hyperlipoproteinemia such as chylomicronemia syndrome and raised Lp(a) are described herein.

  • lipoprotein apheresis in patients with maximally tolerated lipid lowering therapy lipoprotein a Hyperlipoproteinemia and progressive cardiovascular disease
    Circulation, 2013
    Co-Authors: Josef Leebmann, U Julius, Eberhard Roeseler, Franz Heigl, Ralf Spitthoever, Dennis Heutling, Paul Breitenberger, Winfried Maerz, Walter Lehmacher, Andreas Heibges
    Abstract:

    Background—Lipoprotein(a) (Lp(a)) Hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. Methods and Results—In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-Hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein chol...