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Published on: October 12, 2017
Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and
Guochun Wang1, Maoyin Xia1, Cai Liang1
1The Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China.
Insights
Elevated lipoprotein (a) levels are a significant risk factor for adverse cardiovascular events in acute coronary syndrome (ACS) patients. This meta-analysis confirms that high lipoprotein (a) independently predicts major adverse cardiovascular events and mortality in ACS.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
- Epidemiology
Background:
- Elevated lipoprotein (a) is an independent risk factor for adverse cardiovascular events in acute coronary syndrome (ACS).
- Limited consensus exists regarding the prognostic significance of elevated lipoprotein (a) in ACS.
- This study systematically reviews and meta-analyzes the prognostic relevance of elevated lipoprotein (a) in ACS patients.
Approach:
- Systematic literature search of PubMed, Embase, and Cochrane databases up to September 2023.
- Inclusion of cohort studies examining elevated lipoprotein (a) and major adverse cardiovascular events (MACE) in ACS.
- Meta-analysis of aggregated multivariable hazard ratios (HR) and 95% confidence intervals (CI) to assess prognostic implications.
Key Points:
- Elevated lipoprotein (a) was independently associated with increased MACE risk (HR 1.26; 95% CI: 1.17-1.35).
- Elevated lipoprotein (a) was independently associated with increased all-cause mortality (HR 1.36; 95% CI: 1.05-1.76).
- The cut-off for high lipoprotein (a) varied across studies (12.5–60 mg/dL).
Conclusions:
- Elevated lipoprotein (a) levels independently predict MACE and all-cause mortality in ACS patients.
- Assessing lipoprotein (a) levels shows promise for risk stratification in ACS.
- Lipoprotein (a) assessment can inform secondary prevention strategies for ACS patients.
Background:
Elevated lipoprotein (a) level was recognized as an independent risk factor for significant adverse cardiovascular events in acute coronary syndrome (ACS) patients. Despite this recognition, the consensus in the literature regarding the prognostic significance of elevated lipoprotein (a) in ACS was also limited. Consequently, we conducted a thorough systematic review and meta-analysis to evaluate the prognostic relevance of elevated lipoprotein (a) level in individuals diagnosed with ACS.
Methods And Results:
A thorough literature review was conducted by systematically searching PubMed, Embase, and Cochrane databases until September 2023. This review specifically examined cohort studies exploring the prognostic implications of elevated lipoprotein (a) level in relation to major adverse cardiovascular events (MACE), including death, stroke, non-fatal myocardial infarction (MI), and coronary revascularization, in patients with ACS. The meta-analysis utilized aggregated multivariable hazard ratios (HR) and their respective 95% confidence intervals (CI) to evaluate prognostic implications between high and low lipoprotein (a) levels [the cut-off of high lipoprotein (a) level varies from 12.5 to 60 mg/dl]. Among 18,168 patients in the identified studies, elevated lipoprotein (a) was independently associated with increased MACE risk (HR 1.26; 95% CI: 1.17-1.35, P < 0.00001) and all-cause mortality (HR 1.36; 95% CI: 1.05-1.76, P = 0.02) in ACS patients. In summary, elevated lipoprotein (a) levels independently forecast MACE and all-cause mortality in ACS patients. Assessing lipoprotein (a) levels appears promising for risk stratification in ACS, offering valuable insights for tailoring secondary prevention strategies.
Systematic Review Registration:
PROSPERO (CRD42023476543).
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