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This crossover study evaluated the use of lipoprotein apheresis in patients with refractory angina and elevated lipoprotein(a) levels. 20 patients with refractory angina and a lipoprotein(a) level > 500 mg/L were randomised to 3 months of blinded weekly lipoprotein apheresis or sham apheresis, followed by crossover to the alternate treatment arm. The primary end-point was change in quantitative myocardial perfusion reserve (MPR) assessed by cardiovascular magnetic resonance. MPR increased after apheresis compared with sham (+0.47 vs −0.16), yielding a net treatment increase of 0.63 (p<0.001). Improvements with apheresis compared with sham were also seen for atherosclerotic burden, exercise capacity, 4 of 5 domains of the Seattle angina questionnaire, and quality of life. Although apheresis for hypercholesterolaemia is not widely used in Australia due to its cost and complexity, it is more commonly used overseas. This study suggests that this therapy improves symptom control in patients with refractory symptoms and elevated lipoprotein(a), presumably due to regression of atherosclerosis. This technique may become obsolete with the advent of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, which, although expensive, are cheaper than apheresis, and decrease low-density lipoprotein and lipoprotein(a) much more than statins. Australian Research Review subscribers can claim CPD/CME points for time spent reading our reviews from a wide range of local medical and nursing colleges. Find out more on our CPD page. Reviews are prepared with an independent commentary from relevant specialists. To become a reviewer please email geoff@researchreview.com.au. Research Review Australia Pty Ltd is an independent Australian publisher. Research Review receives funding from a variety of sources including Government depts., health product companies, insurers and other organisations with an interest in health. Journal content is created independently of sponsor companies with assistance from leading local specialists. Privacy Policy: Research Review will record your email details on a secure database and will not release them to anyone without your prior approval. Research Review and you have the right to inspect, update or delete your details at any time. Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal.
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