Association between Lipoprotein(a) and premature atherosclerotic cardiovascular disease: a systematic review and meta-analysis
Xu Tian, Nan Zhang, Gary Tse, Guangping Li, Yihong Sun, Tong LiuAbstract
Background and aims
High Lipoprotein(a) [Lp(a)] level has been demonstrated as an important risk factor for atherosclerotic cardiovascular diseases (ASCVD) amongst the older populations, whereas its effects in the younger population remain unclear. This study evaluated the associations between Lp(a) and the risk of premature ASCVD.
Method and results
PubMed and Embase were searched for related studies until Nov 12, 2023. 51 studies including 100,540 participants were included. Mean age of patients ranged from 35.3 to 62.3 years. The proportion of male participants ranged from 0% to 100%. The mean follow-up was provided in five studies ranging from one year to 40 years. The definition of elevated Lp(a) varied among studies, such as >30mg/dL, > 50mg/dL, the top tertiles, the top quartiles, the top quatiles and so on. Higher Lp(a) was significantly associated with the composite ASCVD (OR: 2.15, 95% CI: 1.53-3.02, P < 0.001), especially for CAD (OR: 2.44, 95%CI: 2.06-2.90, P < 0.001) and PAD (OR: 2.56, 95%CI: 1.56-4.21, P < 0.001). This association remained significant in familial hypercholesterolemia (FH) (OR: 3.11, 95%CI: 1.63-5.96, P < 0.001) and type 2 diabetes mellitus (T2DM) patients (OR: 2.23; 95%CI: 1.54-3.23, P < 0.001).Significant results were observed in South Asians (OR: 3.71, 95%CI: 2.31-5.96, P < 0.001), Caucasians (OR: 3.17, 95%CI: 2.22-4.52, P < 0.001), and patients with baseline low density lipoprotein cholesterol (LDL-C) level ≥ 2.6mmol/L.
Conclusion
Elevated Lp(a) predicts the risk of the composite or individual ASCVD in young, regardless of study design, gender, population characteristics (community or hospitalized), different premature definitions, and various Lp(a) measurement approaches. And this association was important in South Asians, Caucasians, FH patients, T2DM patients and patients with baseline LDL-C level ≥ 2.6mmol/L.