Association between lipoprotein(a) and premature atherosclerotic cardiovascular disease: a systematic review and...

Area of Science:

• Cardiovascular Medicine
• Genetics
• Epidemiology

Background:

• High lipoprotein(a) [Lp(a)] is a known risk factor for atherosclerotic cardiovascular diseases (ASCVD) in older adults.
• The impact of elevated Lp(a) on ASCVD risk in younger populations remains less understood.

Purpose of the Study:

• To evaluate the association between Lp(a) levels and the risk of premature ASCVD.
• To synthesize evidence from existing studies on Lp(a) and early-onset ASCVD.

Main Methods:

• A systematic literature search of PubMed and Embase was conducted up to November 12, 2023.
• Meta-analysis of 51 studies involving 100,540 participants was performed.
• Analysis considered various definitions of elevated Lp(a) and population subgroups.

Main Results:

• Higher Lp(a) levels were significantly associated with increased risk of composite ASCVD (OR: 2.15), coronary artery disease (OR: 2.44), and peripheral arterial disease (OR: 2.56).
• The association remained significant in patients with familial hypercholesterolemia (OR: 3.11) and type 2 diabetes mellitus (OR: 2.23).
• Elevated Lp(a) risk was notable in South Asians (OR: 3.71) and Caucasians (OR: 3.17), and in those with baseline LDL-c ≥ 2.6 mmol/L.

Conclusions:

• Elevated Lp(a) is a significant predictor of premature ASCVD in young individuals.
• This association is robust across diverse study designs, populations, and Lp(a) measurement methods.
• Lp(a) is a critical risk factor in specific ethnic groups and in patients with hypercholesterolemia or diabetes.