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Lipoprotein(a) and secondary prevention of atherothrombotic events: A critical appraisal

Michael B Boffa1, Saverio Stranges2, Neil Klar3

  • 1Department of Biochemistry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.

Journal of Clinical Lipidology
|October 15, 2018
PubMed

Insights

Elevated lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular disease. Research on Lp(a) in patients with existing heart disease shows inconsistent results, possibly due to index event bias.

Area of Science:

  • Cardiovascular Medicine
  • Lipidology
  • Atherosclerosis Research

Background:

  • Elevated lipoprotein(a) [Lp(a)] is an established risk factor for atherothrombotic diseases, primarily based on studies of first events.
  • Inconsistent findings exist regarding Lp(a)'s impact on secondary atherothrombotic events in patients with pre-existing cardiovascular disease (CVD).
  • This is critical as secondary prevention populations are targets for Lp(a) screening and emerging Lp(a)-lowering therapies.

Purpose of the Study:

  • To review the secondary prevention literature concerning lipoprotein(a) [Lp(a)].
  • To identify potential confounding factors contributing to inconsistent findings in this population.
  • To address the clinical significance of Lp(a) in patients with established CVD.

Main Methods:

  • Systematic review of published literature on Lp(a) and secondary atherothrombotic events.
  • Analysis of studies investigating Lp(a) levels in patients with pre-existing cardiovascular disease.
  • Exploration of potential biases, including index event bias, in the existing research.

Main Results:

  • The literature presents conflicting data on the role of elevated Lp(a) in predicting recurrent atherothrombotic events.
  • Index event bias is highlighted as a significant confounding factor potentially explaining discrepancies.
  • Further research is needed to clarify Lp(a)'s precise role in secondary cardiovascular prevention.

Conclusions:

  • The impact of elevated lipoprotein(a) [Lp(a)] on secondary atherothrombotic events requires further clarification.
  • Index event bias may confound current understanding of Lp(a) in secondary prevention.
  • Accurate assessment of Lp(a)'s risk in patients with established CVD is crucial for guiding future therapeutic strategies.

Keywords:
Atherothrombotic diseaseClinical studiesConfoundingCoronary heart diseaseEpidemiologyRisk factors

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