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Background Recently it has been demonstrated that elevated lipoprotein (a) (LPA) levels are associated with an increased risk of cardiovascular disease across multiple ethnic groups. However, there is only scanty data about the incidence of elevated LPA levels in different patient cohorts. As a consequence, we aimed to examine whether patients with elevated LPA levels might be seen more often in a cardiovascular center in comparison to the general population. Methods We reviewed LPA concentrations of 52,898 consecutive patients who were admitted to our hospital between January 2004 and December 2014. We subdivided them into different groups according to their LPA levels. Data was compared to available information in medical literature. Results 26.4% of the patients had LPA levels >30 mg/dl which is in line with the data from literature. Mean level of LPA concentration in our study was twice as high in comparison to the general population (25.8% vs. 13.3%). 4.6% had LPA levels >98 mg/dl (general population 30 mg/dl is comparable to the general population but mean levels over all are twice as high and the proportion of patients with LPA levels of >98 mg/dl is extremely higher.

Elevated lipoprotein(a) (Lp(a)) levels are an accepted risk factor for coronary heart disease. The role of Lp(a) in the development of extracardiac arteriosclerosis like peripheral arterial disease (PAD) and stenosis of the arteria carotis (ACIS) has hardly been documented so far. We aimed to investigate the incidence of extracardiac arteriosclerosis in individuals with elevated Lp(a) values.In our center, we measured Lp(a) levels in 31,734 consecutive patients over 5 years. Of these, 1411 patients were selected retrospectively for the presented analysis. Patients were matched according to age, sex, and other accepted cardiovascular risk factors and were assigned to 6 groups according to their Lp(a) values. Retrospectively, we analysed the incidence of PAD and ACIS.In the group with Lp(a) values 2 mg/dl the incidence of PAD was 1.9 % (ACIS 2.8 %), in the group with Lp(a) 23-29 mg/dl 7.3 % (6.1 %), 30-60 mg/dl 9.0 % (8.3 %), 60-91 mg/dl 11.4 % (7.9 %), 91-110 mg/dl 8.6 % (6.0 %) and 110 mg/dl 12.7 % (10.9 %). None of the patients had LDL levels 130 mg/dl or HbA1c 6.1 %.Elevated Lp(a) levels seem to be associated with an increased incidence of PAD and ACIS. Even Lp(a) concentrations between 23 and 29 mg/dl show a threefold increased risk of PAD when compared to patients with Lp(a) 2 mg/dl. However, these findings have to be verified in large prospective studies. In this context cut-off values have to be reevaluated as well.

Ein Zusammenhang zwischen erhohten Lp(a)-Werten und der Inzidenz der KHK ist eindeutig belegt. Die Bedeutung einer Lp(a)-Erhohung fur die Entstehung einer Arteriosklerose mit extrakardialer Manifestation ist bisher nur wenig untersucht. Inwieweit ein erhohter Lp(a)-Wert als eigenstandiger Risikofaktor fur das Auftreten einer peripheren arteriellen Verschlusskrankheit (pAVK) und einer Stenose der Arteria carotis interna (ACIS) gesehen werden kann, war Ziel der vorliegenden Untersuchung. In unserer Klinik wurde uber 5 Jahre bei 31.734 konsekutiven Patienten ein Lp(a)-Wert bestimmt. Hiervon wurden 1411 Patienten retrospektiv fur diese Studie rekrutiert. Die Patienten wurden nach Matching hinsichtlich Alter, Geschlecht und ubriger Risikofaktoren in sechs etwa gleich grose Gruppen gemas des erhobenen Lp(a)-Wertes eingeteilt. Wir bestimmten die Haufigkeit einer pAVK und einer ACIS. Keiner der Patienten hatte ein LDL > 130 mg/dl oder ein HbA1c ≥ 6,1 %. In der Gruppe mit Lp(a)-Werten 110 mg/dl 12,7 % (10,9 %). Es besteht ein Zusammenhang zwischen der Lp(a)-Konzentration und dem Auftreten einer nichtkardialen Arteriosklerose. Bereits Lp(a)-Konzentrationen

Introduction Low density lipoprotein (LDL-C) apheresis is a last treatment option for hypercholesterolemic patientsresistant to conservative lipid-lowering therapy. In a retrospective analysis of 8,533 heparin-induced extra-corporeal LDL precipitation apheresis treatments (HELP), we evaluated the efficacy of LDL reduction, the rate of adverse events, and the progression of atherosclerosis. Methods Between July 1992 and April 2009, we performed 8,533 HELP apheresis therapies in patients with familial hypercholesterolemia (FH). Inclusion criteria were FH with insufficient lipidological status under optimal drug therapy and diet, and at least 50 HELP therapies. Left ventricular function and valvular status was checked prior to the first apheresis therapy and at the end of the individual HELP program. Blood samples were taken directly before and after each therapy. Blood count, electrolytes, total cholesterol, LDL–C, high density lipoprotein (HDL–C), triglycerides, lipoprotein (a) (Lp(a)), and fibrinogen were measured. Adverse events were documented weekly. Results We evaluated 27 patients (19 men) with FH (age 49.2 ± 12.5 years (range 10–67 years)). The number of HELP treatments once weekly was between 50 and 790 applications. Mean follow-up time was 7.0 ± 5.2 years (range 1.3–16.6 years). Prior to the individual apheresis program, 44.4% of the patients had a three vessel disease (VD; 25.9% two VD, 25.9% one VD) and 7.4% had a peripheral arterial occlusive disease. During the time of HELP treatment, none of the patients had a myocardial infarction; 3.7% had one percutaneous coronary intervention (PCI), 11.1% two PCI, 14.8% three PCI, 11.1% ³ four PCI. The patients received 1.2 ± 1.6 (range 0–5) PCI during follow-up time. Adverse events directly associated with HELP therapy were very rare (