Department of Cardiology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO. 16766, Jingshi Road, Jinan city, Jinan, 250014, Shandong Province, China.
Department of Geriatrics, Municipal Hospital of Zibo City, Zibo City, 255000, Shandong Province, China.
Lipids Health Dis. 2019 Jul 8;18(1):150. doi: 10.1186/s12944-019-1092-6.
Elevated lipoprotein (a) is recognized as a risk factor for incident cardiovascular events in the general population and established cardiovascular disease patients. However, there are conflicting findings on the prognostic utility of elevated lipoprotein (a) level in patients with coronary artery disease (CAD).Thus, we performed a meta-analysis to evaluate the prognostic value of elevated lipoprotein (a) level in CAD patients.
A systematic literature search of PubMed and Embase databases was conducted until April 16, 2019. Observational studies reporting the prognostic value of elevated lipoprotein (a) level for cardiac events (cardiac death and acute coronary syndrome), cardiovascular events (death, stroke, acute coronary syndrome or coronary revascularisation), cardiovascular death, and all-cause mortality in CAD patients were included. Pooled multivariable adjusted risk ratio (RR) and 95% confidence interval (CI) for the highest vs. the lowest lipoprotein (a) level were utilized to calculate the prognostic value. Seventeen studies enrolling 283,328 patients were identified. Meta-analysis indicated that elevated lipoprotein (a) level was independently associated with an increased risk of cardiac events (RR 1.78; 95% CI 1.31-2.42) and cardiovascular events (RR 1.29; 95% CI 1.17-1.42) in CAD patients. However, elevated lipoprotein (a) level was not significantly associated with an increased risk of cardiovascular mortality (RR 1.43; 95% CI 0.94-2.18) and all-cause mortality (RR 1.35; 95% CI 0.93-1.95).
Elevated lipoprotein (a) level is an independent predictor of cardiac and cardiovascular events in CAD patients. Measurement of lipoprotein (a) level has potential to improve the risk stratification among patients with CAD.
脂蛋白（a）升高被认为是普通人群和已确诊心血管疾病患者发生心血管事件的一个风险因素。然而，在冠心病患者中，脂蛋白（a）升高水平的预后预测价值存在争议。因此，我们进行了一项荟萃分析，以评估脂蛋白（a）升高水平在冠心病患者中的预后价值。
对 PubMed 和 Embase 数据库进行了系统的文献检索，检索时间截至 2019 年 4 月 16 日。纳入了报告脂蛋白（a）升高水平对心脏事件（心脏死亡和急性冠状动脉综合征）、心血管事件（死亡、卒 中、急性冠状动脉综合征或冠状动脉血运重建）、心血管死亡和全因死亡率的预后价值的观察性研究。采用最高与最低脂蛋白（a）水平的多变量调整风险比（RR）和 95%置信区间（CI）来计算预后价值。确定了纳入 283328 例患者的 17 项研究。荟萃分析表明，脂蛋白（a）升高水平与冠心病患者发生心脏事件（RR 1.78；95%CI 1.31-2.42）和心血管事件（RR 1.29；95%CI 1.17-1.42）的风险增加独立相关。然而，脂蛋白（a）升高水平与心血管死亡率（RR 1.43；95%CI 0.94-2.18）和全因死亡率（RR 1.35；95%CI 0.93-1.95）的风险增加无显著相关性。
脂蛋白（a）升高水平是冠心病患者心脏和心血管事件的独立预测因子。脂蛋白（a）水平的测量可能有助于改善冠心病患者的风险分层。
