An abundance of epidemiological evidence demonstrates that elevated lipoprotein(a) (Lp(a)) represents a significant contributing risk factor towards the development of cardiovascular disease. In particular, raised Lp(a) may play a mechanistic role in patients with refractory angina. Studies have also shown a correlation between oxidised LDL (oxLDL) levels and atherosclerotic burden as well as rates of cardiovascular events. Antibodies against oxLDL (anti-oxLDL) are involved in the removal of oxLDL. Lipoprotein apheresis (LA), which removes lipoproteins using extra-corporeal processes, is an established means of reducing Lp(a), and thereby reduces cardiovascular events. The aim of this study was to investigate the effect of LA on oxLDL and anti-oxLDL levels amongst those with refractory angina in the context of raised Lp(a). Methods: We performed a sub-study within a randomised controlled crossover trial involving 20 patients with refractory angina and raised Lp(a) > 500 mg/L, comparing the effect of three months of blinded weekly LA or sham, followed by crossover to the opposite study arm. We utilized enzyme-linked immunosorbent assays (ELISA) to quantify oxLDL and IgG/ IgM anti-oxLDL antibody levels at baseline and following three months of active LA or sham sessions. Results: Following three months of LA, there was a 30% reduction in oxLDL from 0.37 ± 0.06 to 0.26 ± 0.04 with a mean drop of −0.11 units (U) (95% CI −0.13, −0.09) compared to no significant change with sham therapy (p < 0.0001 between treatment arms). LA also led to a 22% reduction in levels of IgG and IgM anti-oxLDL, again with no significant change demonstrated during sham (p = 0.0036 and p = 0.012, respectively, between treatment arms). Conclusion: Amongst patients with refractory angina in the context of elevated Lp(a), LA significantly lowers levels of oxLDL and anti-oxLDL antibodies, representing potential mechanisms by which LA yields symptomatic and prognostic benefits in this patient cohort.

中文翻译：

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在难治性心绞痛和脂蛋白升高患者的随机对照试验中，脂蛋白置换降低了氧化的LDL和抗氧化的LDL抗体（a）

大量的流行病学证据表明，脂蛋白（a）（Lp（a））升高是心血管疾病发展的重要危险因素。特别是，升高的Lp（a）可能在难治性心绞痛患者中起机械作用。研究还显示了氧化的低密度脂蛋白（oxLDL）水平与动脉粥样硬化负担以及心血管事件发生率之间的相关性。针对oxLDL的抗体（anti-oxLDL）参与了oxLDL的去除。使用体外过程去除脂蛋白的脂蛋白单采血液分离术（LA）是降低Lp（a）从而减少心血管事件的既定手段。这项研究的目的是研究在Lp（a）升高的情况下，LA对难治性心绞痛患者中oxLDL和抗oxLDL水平的影响。方法：我们在一项随机对照交叉试验中进行了一项子研究，该试验涉及20例难治性心绞痛且Lp（a）升高> 500 mg / L的患者，比较了三个月的每周盲法LA或假手术的效果，然后与对面的研究手臂。我们利用酶联免疫吸附测定（ELISA）来定量基线和活动LA或假手术三个月后的oxLDL和IgG / IgM抗oxLDL抗体水平。结果：在LA的三个月后，oxLDL从0.37±0.06降低了30％，降至0.26±0.04，平均下降了-0.11单位（U）（95％CI -0.13，-0.09），而没有明显变化假治疗（p治疗臂之间<0.0001）。LA还导致IgG和IgM抗oxLDL的水平降低了22％，再次在假手术期间未显示出明显的变化（治疗组之间分别为p = 0.0036和p = 0.012）。结论：在Lp（a）升高的情况下的难治性心绞痛患者中，LA显着降低了oxLDL和抗oxLDL抗体的水平，代表了LA在该患者队列中产生症状和预后益处的潜在机制。