Departments of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
Curr Probl Cardiol. 2024 Apr;49(4):102439. doi: 10.1016/j.cpcardiol.2024.102439. Epub 2024 Jan 30.
BACKGROUND: Rising incidence of heart failure (HF) in the Western world despite advanced clinical care necessitate exploration of further preventive tools and strategies. Lipoprotein(a) [Lp(a)], recognized as one of the major cardiovascular risk factors has also been implicated as a risk factor for HF. However, existing evidence remains inconclusive and that has led us to perform this meta-analysis. METHODS: PubMed/Medline, EMBASE and Scopus were systematically searched for studies evaluating an association of Lp(a) with occurrence of HF from inception-till November 2023. Random effects models and I statistics were used for pooled odds ratio (OR) and heterogeneity assessment. We performed leave one out sensitivity analyses by sequentially removing one study at a time and recalculating the pooled effect size. RESULT: Our search rendered in total 360 studies and after final screening this resulted in 7 Mendelian randomization (MR) design. According to the MR analysis, increasing Lp(a) level were significantly associated with increased risk of HF (OR 1.064, 95 % CI: 1.043-1.086, I= 97.59 %, P < 0.001). In addition, Leave-one-out sensitivity analysis showed that the effect size did not change substantially by removal of any particular study in MR studies and ORs ranged from 1.051 (when excluding Levin) to a maximum of 1.111 (when excluding Wang or Jiang), hereby confirming the association. CONCLUSION: We were able to show that by meta-analysis of MR data, increasing lipoprotein (a) levels are associated with an increased risk of HF. Whether this is due to a direct effect on heart muscle contraction or whether this is due to an increased risk of ischemic cardiac disease remains to be elucidated.
背景:尽管西方世界的临床护理水平先进,但心力衰竭(HF)的发病率仍在上升,因此需要探索更多的预防工具和策略。脂蛋白(a)[Lp(a)]已被确认为主要心血管危险因素之一,也与 HF 风险相关。然而,现有证据仍不明确,这促使我们进行了这项荟萃分析。
方法:系统检索了 PubMed/Medline、EMBASE 和 Scopus 数据库,以评估从研究开始到 2023 年 11 月期间 Lp(a)与 HF 发生之间的相关性。使用随机效应模型和 I 统计量评估汇总优势比(OR)和异质性。我们通过依次删除一项研究并重新计算汇总效应大小,进行了一项剔除一个研究的敏感性分析。
结果:我们的搜索总共产生了 360 项研究,经过最终筛选,最终纳入了 7 项孟德尔随机化(MR)设计的研究。根据 MR 分析,Lp(a)水平升高与 HF 风险增加显著相关(OR 1.064,95%CI:1.043-1.086,I=97.59%,P<0.001)。此外,剔除一个研究的敏感性分析显示,MR 研究中剔除任何特定研究对效应大小的影响不大,OR 值范围从 1.051(剔除 Levin 时)到最高的 1.111(剔除 Wang 或 Jiang 时),从而证实了这种关联。
结论:我们通过对 MR 数据的荟萃分析表明,Lp(a)水平升高与 HF 风险增加相关。这是由于对心肌收缩的直接影响,还是由于缺血性心脏病风险增加所致,仍有待阐明。
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