The association of lipoprotein(a) and coronary artery calcium in asymptomatic patients: a systematic review and meta-analysis

Author:

Martignoni Felipe Villa1ORCID,RL Júnior José Eduardo2,Marques Isabela R3,Gomes Cintia4,Moreira Vittoria Caporal S5,de Souza Isabela A F6,Miyawaki Isabele A7,Silva Caroliny H8,do Amaral Neto Augusto Barreto9,Padrão Eduardo M H10,Cardoso Rhanderson11ORCID,de Vasconcellos Henrique Doria12,Miedema Michael1

Affiliation:

1. Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute , 920 East 28th Street, Minneapolis, MN 55407 , USA

2. Department of Medicine, Hospital Alemão Oswaldo Cruz , São Paulo , Brazil

3. Department of Medicine, Universitat Internacional de Catalunya , Barcelona , Spain

4. Department of Medicine, Federal University of Santa Maria , Santa Maria , Brazil

5. Department of Medicine, University Israelita de Ciências da Saúde Albert Einstein , São Paulo , Brazil

6. Department of Medicine, Petrópolis Medical School , Petrópolis , Brazil

7. Department of Medicine, Federal University of Paraná , Curitiba , Brazil

8. Department of Medicine, Federal University of Rio Grande do Norte , Natal , Brazil

9. Department of Internal Medicine, Central Montana Medical Center , Lewistown , USA

10. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital , Boston , USA

11. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston , USA

12. Department of Anesthesia and Critical Care, Johns Hopkins University Medicine , Baltimore , USA

Abstract

Abstract Aims Lipoprotein(a) [Lp(a)] is an atherogenic lipid particle associated with increased risk for coronary heart disease (CHD) events. Coronary artery calcium (CAC) score is a tool to diagnose subclinical atherosclerosis and guide clinical decision-making for primary prevention of CHD. Studies show conflicting results concerning the relationship between Lp(a) and CAC in asymptomatic populations. We conducted a meta-analysis to evaluate the association of Lp(a) and CAC in asymptomatic patients. Methods and results We systematically searched PubMed, Embase, and Cochrane until April 2023 for studies evaluating the association between Lp(a) and CAC in asymptomatic patients. We evaluated CAC > 0 Agatston units, and CAC ≥ 100. Lp(a) was analysed as a continuous or dichotomous variable. We assessed the association between Lp(a) and CAC with pooled odds ratios (OR) adopting a random-effects model. A total of 23 105 patients from 18 studies were included in the meta-analysis with a mean age of 55.9 years, 46.4% female. Elevated Lp(a) increased the odds of CAC > 0 [OR 1.31; 95% confidence intervals (CI) 1.05–1.64; P = 0.02], CAC ≥100 (OR 1.29; 95% CI 1.01–1.65; P = 0.04; ), and CAC progression (OR 1.43; 95% CI 1.20–1.70; P < 0.01; ). For each increment of 1 mg/dL in Lp(a) there was a 1% in the odds of CAC > 0 (OR 1.01; 95% CI 1.01–1.01; P < 0.01). Conclusion Our findings of this meta-analysis suggest that Lp(a) is positively associated with a higher likelihood of CAC. Higher Lp(a) levels increased the odds of CAC >0. These data support the concept that Lp(a) is atherogenic, although with high heterogeneity and a low level of certainty. Protocol registration CRD42023422034 Key findings Asymptomatic patients with elevated Lp(a) had 31% higher chances of having any coronary calcification (CAC > 0) and 29% higher chances of having more advanced calcification (CAC > 100). It increased the chances of having progression of coronary calcification over time by 43%. For each 1 mg/dL of Lp(a) there was an increment of 1% chance of having coronary calcification.

Publisher

Oxford University Press (OUP)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Editorial comments: focus on cardiovascular risk estimation and prevention;European Journal of Preventive Cardiology;2024-04

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