Lipoprotein(a) and Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Area of Science:

• Cardiology
• Biochemistry
• Epidemiology

Background:

• Atrial fibrillation (AF) is a major global health concern and the most common prolonged cardiac arrhythmia.
• Lipoprotein(a) (Lp(a)) is a genetically determined lipoprotein linked to cardiovascular disease, with a potential but unconfirmed role in AF.

Purpose of the Study:

• To systematically review and meta-analyze observational studies assessing the relationship between circulating lipoprotein(a) levels and atrial fibrillation.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
• Searches conducted across major databases (PubMed, Embase, Web of Science, Scopus, Cochrane, Google Scholar) up to September 2025.
• Included observational studies comparing Lp(a) levels in adults with and without AF.

Main Results:

• A statistically significant elevation in circulating Lp(a) concentrations was observed in AF patients compared to controls (pooled MD = 2.81; 95%CI: 1.58-4.05; p < 0.0001).
• Significant associations were found in subgroup analyses by geographical region (Asia, Europe/USA).
• High heterogeneity (I² = 99%) was noted, though sensitivity analyses confirmed the stability of the overall effect.

Conclusions:

• A significant association exists between elevated lipoprotein(a) and atrial fibrillation.
• The certainty of evidence is rated as very low (GRADE methodology).
• Large, prospective, multi-ethnic studies are required to establish causality, improve risk stratification, and evaluate Lp(a)-lowering therapies for AF.