Aspirin use in patients with elevated lipoprotein(a): Impact on cardiovascular events and bleeding

Area of Science:

• Cardiology
• Pharmacology
• Genetics

Background:

• The role of aspirin in primary cardiovascular prevention is debated.
• Elevated lipoprotein(a) [Lp(a)] presents a risk factor for cardiovascular disease.
• Aspirin's antifibrinolytic and antiplatelet effects may benefit individuals with high Lp(a).

Purpose of the Study:

• To systematically review cardiovascular benefits and bleeding risks of aspirin in patients with elevated Lp(a) and no prior cardiovascular disease.
• To assess aspirin's efficacy in primary prevention for a high-risk subgroup.
• To evaluate safety concerns, specifically bleeding events, associated with aspirin use in this population.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Literature search for studies on aspirin use in patients with elevated Lp(a) or related genetic variants (SNP rs379822) without cardiovascular disease history.
• Inclusion of five studies involving 49,871 individuals, with analyses based on genetic variants or direct Lp(a) measurements.

Main Results:

• Consistent reduction in cardiovascular risk observed in carriers of the apolipoprotein(a) variant or patients with Lp(a) levels > 50 mg/dL using aspirin.
• No significant increase in bleeding events was reported across the included studies.
• Data on bleeding risk remains limited, with events noted in only two studies.

Conclusions:

• Aspirin use may offer cardiovascular risk reduction for individuals with elevated Lp(a) levels and no history of cardiovascular disease.
• Further investigation is warranted to fully ascertain the bleeding risks associated with aspirin in this specific patient group.
• This review supports exploring aspirin's role in primary prevention for those with high Lp(a).