There are 2 clinical trials
The goal of this study is to determine the impact of apheresis on clinical parameters and symptoms of patients with refractory angina and raised Lp(a). The investigators will conduct a prospective, randomised controlled crossover study of 20 patients with refractory angina and raised Lp(a), randomised to undergoing lipoprotein apheresis weekly for three months or sham apheresis weekly for three months with assessment of myocardial perfusion, carotid atherosclerosis, endothelial vascular function, thrombogenesis, exercise capacity, angina symptoms and quality of life at the beginning and end of treatment. Patients will then crossover to the opposite study arm with the protocol repeated. The hypothesis is that the above parameters will be improved by lipoprotein apheresis in patients with raised Lp(a) and Refractory Angina. Investigators will also test for the genotypic presence of apolipoprotein(a) gene (LPA) locus variants (rs10455872 and rs3798220) which are thought to be associated with an increased level of Lp(a) and an increased risk of coronary disease.
Investigators will also test for the genotypic presence of apolipoprotein(a) gene (LPA) locus variants (rs10455872 and rs3798220) which are thought to be associated with an increased level of Lp(a) and an increased risk of coronary disease.
Description: Baseline compare to 3 month, changes presented Determine the impact of lipoprotein apheresis on quantitative myocardial perfusion measured by stress/rest cardiovascular magnetic resonance imaging. Increase means better outcome
Measure: Changes in Quantitative Myocardial Perfusion Measured by Stress/Rest Cardiovascular Magnetic Resonance Imaging Time: 3 monthsDescription: Changes from baseline to 3 months
Measure: Change in Carotid Atherosclerosis/Plaque Burden Determined by Cardiovascular Magnetic Resonance Imaging Time: 3 monthsDescription: EndoPat LnRHI - natural logarithm of reactive hyperaemia index. Increase - better outcome
Measure: Change in Endothelial Vascular Function Time: Within 7 days before and after 3 months of weekly lipoprotein apheresisDescription: SAQ-Angina stability, increase means improvement. 0-100 scale, Higher score means improvements
Measure: Change in Seattle Angina Questionnaire Score Time: 3 monthsDescription: Quality of Life score following, 0-100 score, high score improve quality of life
Measure: Change in SF-36 Quality of Life Score Time: 3 monthsDescription: Six minute walk test, patient can walk longer distance means improvements
Measure: Change in Exercise Capacity Determined by Six Minute Walk Test Time: 3 monthsDescription: Thrombogenesis, Reduce value is better to the patients
Measure: Changes in Markers of Thrombogenesis Time: 3 monthsThe aim of study is to examine the relationship between lipid subfractions, inflammation and structural-functional properties of the arterial wall in patients with premature coronary heart disease, to study genetic polymorphisms that determine lipid subfractions concentration on the functional and morphological properties of the arterial vascular wall in patients with early coronary heart disease, to study the effect of alirocumab and evolocumab on lipid subfractions, inflammation and structural-functional properties of arterial wall in patients with early coronary atherosclerosis and to study the influence of NOS-3 gene expression on the functional and morphological properties of the arterial vascular wall in the same patients. Impaired blood fat metabolism and chronic inflammation are intertwined as possible causes of atherosclerosis. Lipoprotein (a) (Lp (a)) is an important risk factor for coronary heart disease and a prognostic predictor in patients after myocardial infarction, but recent research suggests that subtilisin-kexin convertase type 9 (PCSK9) inhibitors are the only drugs that significantly reduce serum Lp (a) concentration. However, there are no data on the relationship between Lp (a) values and polymorphisms for Lp (a), indicators of inflammation and impaired arterial function, and response to treatment with various PCSK9 inhibitors in patients with early coronary heart disease.
Within LPA, the number of KIV2 copies, as well as one nucleotide polymorphism (SNP), rs3798220 and rs10455872, is associated with Lp (a) concentration and coronary heart disease.
Description: Functional and morphological characteristics of arterial wall will correlate to Lp (a) concentrations.
Measure: Ultrasound functional and morphological properties of the arterial wall and Lp (a) concentration Time: BaselineDescription: The serum concentration of Lp (a) will correlate with single nucleotide polymorphisms (SNP) in the LPA gene
Measure: Concentration of Lp (a) and SNP in the LPA gene Time: BaselineDescription: Both drugs will improve functional and morphological properties of arterial wall in with no difference between the drugs. We expect the improvements in each drug group will be in correlation with the decrease of Lp (a) concentration.
Measure: The effect of alirocumab or evolocumab on functional and morphological properties of arterial wall after 6 months Time: 6 months