脂蛋白(a)与钙化性主动脉瓣疾病的发生和进展:系统评价和荟萃分析。

Lipoprotein(a) and calcific aortic valve disease initiation and progression: a systematic review and meta-analysis.

机构信息

3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece.

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.

出版信息

Cardiovasc Res. 2023 Jul 6;119(8):1641-1655. doi: 10.1093/cvr/cvad062.

Abstract

Although evidence indicates the association of lipoprotein(a) [Lp(a)] with atherosclerosis, the link with calcific aortic valve disease (CAVD) is unclear. This systematic review and meta-analysis explores the connection between Lp(a) and aortic valve calcification and stenosis (AVS). We included all relevant studies, indexed in eight databases, up to February 2023. A total of 44 studies (163 139 subjects) were included, with 16 of them being further meta-analysed. Despite considerable heterogeneity, most studies support the relationship between Lp(a) and CAVD, especially in younger populations, with evidence of early aortic valve micro-calcification in elevated-Lp(a) populations. The quantitative synthesis showed higher Lp(a) levels, by 22.63 nmol/L (95% CI: 9.98-35.27), for patients with AVS, while meta-regressing the data revealed smaller Lp(a) differences for older populations with a higher proportion of females. The meta-analysis of eight studies providing genetic data, revealed that the minor alleles of both rs10455872 and rs3798220 LPA gene loci were associated with higher risk for AVS (pooled odds ratio 1.42; 95% CI: 1.34-1.50 and 1.27; 95% CI: 1.09-1.48, respectively). Importantly, high-Lp(a) individuals displayed not only faster AVS progression, by a mean difference of 0.09 m/s/year (95% CI: 0.09-0.09), but also a higher risk of serious adverse outcomes, including death (pooled hazard ratio 1.39; 95% CI: 1.01-1.90). These summary findings highlight the effect of Lp(a) on CAVD initiation, progression and outcomes, and support the early onset of Lp(a)-related subclinical lesions before clinical evidence.

摘要

尽管有证据表明脂蛋白(a)[Lp(a)]与动脉粥样硬化有关,但与钙化性主动脉瓣疾病(CAVD)的联系尚不清楚。本系统评价和荟萃分析探讨了 Lp(a)与主动脉瓣钙化和狭窄(AVS)之间的关系。我们纳入了截至 2023 年 2 月在八个数据库中索引的所有相关研究。共纳入 44 项研究(163139 例受试者),其中 16 项进行了进一步的荟萃分析。尽管存在很大的异质性,但大多数研究支持 Lp(a)与 CAVD 之间的关系,特别是在年轻人群中,在 Lp(a)升高的人群中,有证据表明早期主动脉瓣微钙化。定量综合结果表明,AVS 患者的 Lp(a)水平升高 22.63 nmol/L(95%CI:9.98-35.27),而对数据进行元回归分析表明,女性比例较高的老年人群中 Lp(a)差异较小。对提供遗传数据的 8 项研究进行荟萃分析显示,LPA 基因座 rs10455872 和 rs3798220 的次要等位基因与 AVS 的风险增加相关(汇总优势比 1.42;95%CI:1.34-1.50 和 1.27;95%CI:1.09-1.48)。重要的是,高 Lp(a)个体不仅表现出 AVS 进展更快,平均差异为 0.09 m/s/年(95%CI:0.09-0.09),而且严重不良结局的风险更高,包括死亡(汇总危险比 1.39;95%CI:1.01-1.90)。这些综合发现强调了 Lp(a)对 CAVD 起始、进展和结局的影响,并支持在临床证据出现之前,Lp(a)相关亚临床病变的早期发生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e8c/10702855/58151fad3dad/cvad062_ga1.jpg

本文引用的文献

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索