Lipoprotein(a) (Lp(a)) exhibits proinflammatory and proatherogenic properties. Evidence from prospective epidemiological studies, as well as Mendelian randomization studies, reveals an independent and causal association between elevated Lp(a) concentrations and atherosclerotic cardiovascular disease (ASCVD). Lipoprotein apheresis (LA) effectively lowers atherogenic lipoproteins when medication is insufficient. Since 2008, LA reimbursement for patients with high Lp(a) (> 60 mg/dL) and progressive ASCVD has been approved in Germany. To justify this policy, German authorities required prospective data, leading to the conduct of the Pro(a)LiFe study and establishment of the German Lipoprotein Apheresis Registry (GLAR). The Pro(a)LiFe study enrolled 170 patients with high Lp(a) and progressive ASCVD to evaluate LA’s long-term effect on cardiovascular event rates. Patients were investigated for 5 years before initiation of regular LA, then up to 12 years afterwards. Results showed a significant decline in mean annual cardiovascular events per patient from 0.27 (±0.25) in the 5 years before LA to 0.06 (±0.08) over the following 12 years (p < 0.001). Compared to a matched UK Biobank cohort, ASCVD event rates were higher before LA began and significantly lower afterwards. The results confirm that long-term treatment with LA is associated with low incidences of cardiovascular events in patients with high Lp(a) sustained over 12 years. Combining Lp(a) testing with LA has meaningfully reduced ASCVD events. Until Lp(a)-specific drugs receive regulatory approval, LA remains a viable treatment for selected high-risk patients. It will be important to assess whether results with novel pharmaceutical agents apply to the peculiar high-risk patients with high Lp(a) and progressive ASCVD.