脂蛋白（a）与超敏C反应蛋白相关的主要不良心血管事件的关联：一项系统评价和荟萃分析。
Association of Lipoprotein(a) With Major Adverse Cardiovascular Events Across hs-CRP: A Systematic Review and Meta-Analysis.
作者信息
Alebna Pamela L, Han Chin Yip, Ambrosio Mathew, Kong Gwyneth, Cyrus John W, Harley Kayla, Kang Le, Small Aeron M, Chevli Parag, Bhatia Harpreet, Chew Nicholas, Salloum Fadi N, Dixon Dave L, Abbate Antonio, Natarajan Pradeep, Shapiro Michael D, Mehta Anurag
机构信息
Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
出版信息
JACC Adv. 2024 Nov 19;3(12):101409. doi: 10.1016/j.jacadv.2024.101409. eCollection 2024 Dec.
BACKGROUND
Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. The relationship between Lp(a) and major adverse cardiovascular events (MACE) in the context of high-sensitivity C-reactive protein (hs-CRP) levels remains controversial due to conflicting results from previous studies.
OBJECTIVES
This systematic review and meta-analysis aimed to clarify the association between Lp(a) and risk of MACE across different hs-CRP levels in both primary and secondary prevention settings.
METHODS
We performed a systematic review by searching MEDLINE (PubMed), Embase (Ovid), Cochrane CENTRAL (Wiley), and Web of Science (Clarivate) from their inception to February 2024. Eligible studies reported the association of Lp(a) with MACE stratified by hs-CRP level. Data extraction and quality assessment were systematically conducted. Meta-analyses used random-effects models to compute pooled HRs for individuals with low (<2 mg/L) and high (≥2 mg/L) hs-CRP levels. Subgroup analyses were performed in primary and secondary prevention populations.
RESULTS
Nine publications encompassing 11 studies that involved 562,301 participants met the inclusion criteria. The mean proportion of females was 39.9% and the weighted mean age for the entire cohort was 61.2 years. Elevated Lp(a) was significantly associated with MACE risk in both low and high hs-CRP groups, with pooled HR of 1.26 (95% CI: 1.11-1.42) and 1.33 (95% CI: 1.20-1.47), respectively. In the primary prevention group, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06-1.66) and 1.43 (95% CI: 1.13-1.82), respectively (subgroup difference, = 0.65). The corresponding HRs for the secondary prevention population were 1.13 (95% CI: 1.00-1.27) and 1.31 (95% CI: 1.12-1.52), respectively (subgroup difference = 0.13).
CONCLUSION
Elevated Lp(a) is associated with an increased risk of MACE independent of hs-CRP levels in both primary and secondary prevention populations.
背景
脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病的独立危险因素。由于先前研究结果相互矛盾，在高敏C反应蛋白(hs-CRP)水平背景下，Lp(a)与主要不良心血管事件(MACE)之间的关系仍存在争议。
目的
本系统评价和荟萃分析旨在阐明在一级和二级预防环境中，不同hs-CRP水平下Lp(a)与MACE风险之间的关联。
方法
我们通过检索MEDLINE(PubMed)、Embase(Ovid)、Cochrane CENTRAL(Wiley)和Web of Science(Clarivate)从创刊到2024年2月的数据进行了系统评价。符合条件的研究报告了按hs-CRP水平分层的Lp(a)与MACE的关联。系统地进行了数据提取和质量评估。荟萃分析使用随机效应模型计算hs-CRP水平低(<2mg/L)和高(≥2mg/L)个体的合并风险比(HR)。在一级和二级预防人群中进行了亚组分析。
结果
9篇出版物共11项研究，涉及562301名参与者，符合纳入标准。女性的平均比例为39.9%，整个队列的加权平均年龄为61.2岁。在hs-CRP水平低和高的组中，Lp(a)升高均与MACE风险显著相关，合并HR分别为1.26(95%CI：1.11-1.42)和1.33(95%CI：1.20-1.47)。在一级预防组中，hs-CRP水平低和高的组的合并HR分别为1.33(95%CI：1.06-1.66)和1.43(95%CI：1.13-1.82)(亚组差异，P=0.65)。二级预防人群的相应HR分别为1.13(95%CI：1.00-1.27)和1.31(95%CI：
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