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In part 3 of our Special Report on lipoprotein apheresis, Sperling and Gianos discuss future considerations for use and the evolving landscape of lipid management.
00:00 - Challenges and Barriers in Lipoprotein Apheresis
02:28 - Patient-facing and Clinician-Specific Perspectives
05:30 - Insurance and Health System Challenges
06:39 - Future of Lipoprotein Apheresis
12:07 - Final Thoughts and Recommendations
In contemporary settings within cardiology, the word lipoprotein is enough to conjure excitement and enthusiasm. With the field on the cusp of a potential paradigm shift in the management of lipoprotein(a) [Lp(a)] within the next 18 months, many are optimistic about the potential for additional therapeutic options to improve outcomes in patients with elevated Lp(a).
What often goes unmentioned or overlooked in these conversations is the recognition of an existing US Food and Drug Administration-approved therapy for reducing Lp(a) in lipoprotein apheresis. Beyond this recognition, data and guidelines also support the role of lipoprotein apheresis in certain patients with familial hypercholesterolemia (FH).
The recognition of the potential utility of this therapy in this context and more was the subject of the latest scientific statement from the American Heart Association (AHA). Released on October 07, 2024, the statement, titled “Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association,”, clocks in at 18 pages and length and cites more than 100 references documents. Composed on behalf of several AHA councils, the document was created by a volunteer writing committee led by 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, the third and final segment of this HCPLive Special Report, Sperling and Gianos discuss the evolution, challenges, and future of lipoprotein apheresis in treating patients with severe hypercholesterolemia. Sperling, who has overseen Emory’s lipoprotein apheresis program for more than 20 years, shares insights on the program’s expansion and the barriers faced in providing this treatment, which is currently available in only 33 US states. Sperling goes on to emphasizes the need for greater awareness among clinicians about the benefits of apheresis, which can drastically reduce LDL cholesterol and Lp(a) levels, improve patients' quality of life, and prevent cardiovascular events.
Gianos, who helped establish Northwell Health’s apheresis program, highlights the importance of balancing the inconvenience of frequent treatments with the long-term health benefits for patients. She also discusses the need for more research on patient experiences and the potential for the therapy to address not only lipid reduction but also inflammation and endothelial function. Both experts agree that while emerging therapies for Lp(a) are promising, apheresis remains a vital option for patients who do not respond optimally to existing treatments. Similarly, they both stress the importance of continued education and institutional support to ensure access to this life-saving therapy.
Laurence Sperling has no disclosures to report. Relevant disclosures for Gianos include Amgen, AstraZeneca, Eli Lilly and Company, kaenka, Novartis, and Med-IQ.
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