Vnitr Lek 2016, 62(11):903-907

How to deal ugly twins, LDL-cholesterol and lipoprotein (a)

Jan Piťha^1,2

¹ Interní klinika, 2. LF UK a FN v Motole, Praha

² Laboratoř pro výzkum aterosklerózy, Centrum experimentální medicíny IKEM Praha

LDL cholesterol (LDL-C) remains the primary goal for hypolipidemic therapy as a representative of atherogenic LDL particles. In patients at very high risk, its level should be in the range 0.9-1.6 mmol/l. In patients with progression of atherosclerosis despite treatment, an important role could play high level of lipoprotein (a) - Lp(a), particle with a high atherothrombotic potential. Until now, it was difficult to reduce LDL-C to the desired range by recent therapy: combination of lifestyle changes, high doses of strong statins and ezetimibe. Lp(a) was not affected by these measures at all. Recently, we have the opportunity to reduce significantly LDLc and Lp(a), by two treatment modalities. The first is a lipoprotein apheresis that reduces LDL-C and Lp(a) by 60-80 %. The second one are inhibitors of proprotein convertase subtilisin kexin 9 which lower LDL-C similarly to lipoprotein apheresis; Lp(a), approximately by 25 %. Both methods, or their combination could, therefore, significantly affect prognosis of patients with atherosclerosis out of control, in which the treatment by available therapy have not been successful or not possible for intolerance especially in the case of statins.

Keywords: LDL cholesterol; lipoprotein (a); lipoprotein apheresis; PCSK9 inhibitors

Received: October 31, 2016; Accepted: November 14, 2016; Published: November 1, 2016  Show citation