Ministry of Health Holdings, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107960. doi: 10.1016/j.jstrokecerebrovasdis.2024.107960. Epub 2024 Aug 31.
Lipoprotein(a) [Lp(a)] is an established independent causal risk factor for cardiovascular disease and atherosclerosis. However, its association with young-onset ischemic stroke is not well-established. A systematic review and meta-analysis was performed to investigate the association of elevated Lp(a) with young ischemic stroke.
Four electronic databases: PubMed (MEDLINE), EMBASE, Scopus and Cochrane Library were systematically searched, profiling studies from inception till 6 Mar 2024. We included studies investigating the relationship between stratified Lp(a) levels and young ischemic stroke. We compared the odds of young stroke patients (age <65 years) having elevated Lp(a) compared to age-matched controls without stroke or transient ischemic attack.
Five case-control studies comprising a total of 1345 patients were included; 57.7 % (776/1345) were females, with a mean age of 41.5 years. Among them, 22.5 % (264/1171) were smokers. Additionally, 16.8 % (197/1171) had hypertension, 5.9 % (69/1171) had diabetes, and 29.2 % (284/971) had hyperlipidemia. Young stroke patients were more likely to have high Lp(a) level than age-matched controls (OR 1.61, 95 %CI 1.24-2.10). Four studies defined a high Lp(a) level as ≥30mg/dL, whilst one study used a Lp(a) level of >23.2mg/dL as the cut-off. A sensitivity analysis excluding this study showed that young stroke patients were still more likely to have Lp(a) ≥30mg/dL than controls (OR 1.43, 95 %CI 1.08-1.88).
Young stroke patients are more likely to have elevated Lp(a) compared to age-matched controls, suggesting an association between elevated Lp(a) and young stroke. Further research is warranted to evaluate the causal relationships between Lp(a) and young-onset ischemic stroke, as well as to conduct a cost-benefit analysis of Lp(a) screening in young adults as part of a primary prevention strategy.
脂蛋白（a）[Lp(a)] 是心血管疾病和动脉粥样硬化的独立因果风险因素。然而，其与年轻发病的缺血性卒中的关系尚未得到充分确立。进行了系统评价和荟萃分析，以调查升高的 Lp(a) 与年轻缺血性卒中的关系。
系统检索了四个电子数据库：PubMed（MEDLINE）、EMBASE、Scopus 和 Cochrane Library，从成立到 2024 年 3 月 6 日对研究进行了分析。我们纳入了研究 Lp(a) 分层水平与年轻缺血性卒中之间关系的研究。我们比较了年龄<65 岁的年轻卒中患者（年轻卒中组）与无卒中或短暂性脑缺血发作的年龄匹配对照者（对照组）中 Lp(a) 升高的可能性。
纳入了 5 项病例对照研究，共纳入 1345 例患者；57.7%（776/1345）为女性，平均年龄为 41.5 岁。其中，22.5%（264/1171）为吸烟者。此外，16.8%（197/1171）患有高血压，5.9%（69/1171）患有糖尿病，29.2%（284/971）患有高脂血症。年轻卒中患者的 Lp(a) 水平高于年龄匹配的对照者（OR 1.61，95%CI 1.24-2.10）的可能性更大。4 项研究将高 Lp(a) 水平定义为≥30mg/dL，而 1 项研究将 Lp(a)水平>23.2mg/dL 作为切点。排除这项研究的敏感性分析表明，年轻卒中患者的 Lp(a)水平仍高于对照组（OR 1.43，95%CI 1.08-1.88）。
与年龄匹配的对照者相比，年轻卒中患者的 Lp(a) 水平升高的可能性更大，提示升高的 Lp(a) 与年轻卒中之间存在关联。需要进一步研究以评估 Lp(a) 与年轻发病的缺血性卒中之间的因果关系，并对年轻成年人进行 Lp(a) 筛查作为一级预防策略的成本效益分析。
