Nave Alexander H, Lange Kristin S, Leonards Christopher O, Siegerink Bob, Doehner Wolfram, Landmesser Ulf, Steinhagen-Thiessen Elisabeth, Endres Matthias, Ebinger Martin
Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany; Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany.
Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany.
Atherosclerosis. 2015 Oct;242(2):496-503. doi: 10.1016/j.atherosclerosis.2015.08.021. Epub 2015 Aug 15.
Lipoprotein (a) [Lp(a)] harbors atherogenic potential but its role as a risk factor for ischemic stroke remains controversial. We conducted a meta-analysis to determine the relative strength of the association between Lp(a) and ischemic stroke and identify potential subgroup-specific risk differences.
A systematic search using the MeSH terms "lipoproteins" OR "lipoprotein a" AND "stroke" was performed in PubMed and ScienceDirect for case-control studies from June 2006 and prospective cohort studies from April 2009 until December 20th 2014. Data from eligible papers published before these dates were reviewed and extracted from previous meta-analyses. Studies that assessed the relationship between Lp(a) levels and ischemic stroke and reported generic data-i.e. odds ratio [OR], hazard ratio, or risk ratio [RR]-were eligible for inclusion. Studies that not distinguish between ischemic and hemorrhagic stroke and transient ischemic attack were excluded. Random effects meta-analyses with mixed-effects meta-regression were performed by pooling adjusted OR or RR.
A total of 20 articles comprising 90,904 subjects and 5029 stroke events were eligible for the meta-analysis. Comparing high with low Lp(a) levels, the pooled estimated OR was 1.41 (95% CI, 1.26-1.57) for case-control studies (n = 11) and the pooled estimated RR was 1.29 (95% CI, 1.06-1.58) for prospective studies (n = 9). Sex-specific differences in RR were inconsistent between case-control and prospective studies. Study populations with a mean age of ≤55 years had an increased RR compared to older study populations. Reported Lp(a) contrast levels and ischemic stroke subtype significantly contributed to the heterogeneity observed in the analyses.
Elevated Lp(a) is an independent risk factor for ischemic stroke and may be especially relevant for young stroke patients. Sex-specific risk differences remain conflicting. Further studies in these subgroups may be warranted.
脂蛋白(a)[Lp(a)]具有致动脉粥样硬化的潜力，但其作为缺血性卒中危险因素的作用仍存在争议。我们进行了一项荟萃分析，以确定Lp(a)与缺血性卒中之间关联的相对强度，并识别潜在的亚组特异性风险差异。
在PubMed和ScienceDirect中使用医学主题词“脂蛋白”或“脂蛋白a”以及“卒中”进行系统检索，以查找2006年6月以来的病例对照研究和2009年4月至2014年12月20日的前瞻性队列研究。对这些日期之前发表的符合条件论文的数据进行回顾，并从之前的荟萃分析中提取。评估Lp(a)水平与缺血性卒中之间关系并报告一般数据（即比值比[OR]、风险比或相对危险度[RR]）的研究符合纳入标准。未区分缺血性卒中和出血性卒中以及短暂性脑缺血发作的研究被排除。通过汇总调整后的OR或RR进行随机效应荟萃分析和混合效应荟萃回归。
共有20篇文章符合荟萃分析标准，包括90904名受试者和5029例卒中事件。病例对照研究（n = 11）中，将高Lp(a)水平与低Lp(a)水平进行比较，汇总估计OR为1.41（95%CI，1.26 - 1.57）；前瞻性研究（n = 9）中，汇总估计RR为1.29（95%CI，1.06 - 1.58）。病例对照研究和前瞻性研究中RR的性别特异性差异不一致。平均年龄≤55岁的研究人群与年龄较大的研究人群相比，RR增加。报告的Lp(a)对比水平和缺血性卒中亚型显著导致了分析中观察到的异质性。
Lp(a)升高是缺血性卒中的独立危险因素，可能对年轻卒中患者尤为重要。性别特异性风险差异仍然存在冲突。可能需要在这些亚组中进行进一步研究。
