Senapati Sidhartha Gautam, Borra Vamsikalyan, Kattamuri Lakshmi Prasanna Vaishnavi, Machineni Naga Vamsi Krishna, Borra Nithya, Kukkala Sindhuja, Ramasahayam Karthikeya, Prajapati Kesar, Nayak Parth R, Kale Santosh, Jain Akhil, Vyas Ankit, Desai Rupak
Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Department of Internal Medicine, The University of Texas Rio Grande Valley, Weslaco, TX, USA.
Cardiovasc Diagn Ther. 2025 Feb 28;15(1):163-172. doi: 10.21037/cdt-24-162. Epub 2025 Feb 25.
Elevated levels of lipoprotein(a) [Lp(a)] and diabetes have been identified as potential risk factors for coronary artery disease (CAD). This study investigates various Lp(a) levels' impact on atherosclerotic cardiovascular disease (ASCVD) events in pre-diabetics and diabetics.
We included retrospective studies in English until May 2023, exploring the link between high Lp(a) levels and cardiovascular outcomes in humans with diabetes, prediabetes, or normal glucose levels. Studies were sourced from PubMed, Scopus, and Google Scholar, emphasizing detailed population and outcome data. We excluded studies with major methodological issues, low-quality data, missing key information, duplicates, and non-human subjects. We included high-quality retrospective studies on Lp(a) and cardiovascular outcomes, using risk of bias tools like Newcastle-Ottawa Scale (NOS) to ensure data integrity, and resolved discrepancies through discussion. Binary random-effects models were employed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I statistics. For outcomes showing moderate or high heterogeneity, subgroup analyses were performed for follow-up duration or type of study.
A total of 20,271 patients with diabetes, prediabetes, and non-diabetics were included from three studies. In our analysis, compared to non-diabetics with Lp(a) <10 mg/dL, the risk of ASCVD increased with an increase in Lp(a) levels among pre-diabetics [Lp(a) <10 mg/dL (HR: 1.40, 95% CI: 1.17-1.67), Lp(a) 10-30 mg/dL (HR: 1.60, 95% CI: 1.30-1.96), Lp(a) >30 mg/dL (HR: 2.08, 95% CI: 1.49-2.90)] and diabetics [Lp(a) <10 mg/dL (HR: 2.42, 95% CI: 1.97-2.98), Lp(a) 10-30 mg/dL (HR: 2.26, 95% CI: 1.64-3.12), Lp(a) >30 mg/dL (HR: 4.17, 95% CI: 3.24-5.37)] with statistical significance (P<0.01).
High Lp(a) (>30 mg/dL) is associated with more ASCVD events in diabetics and pre-diabetics . Lp(a) <30 mg/dL, underscoring Lp(a)'s clinical importance in risk stratification and intervention.
脂蛋白(a)[Lp(a)]水平升高和糖尿病已被确定为冠状动脉疾病（CAD）的潜在危险因素。本研究调查了不同Lp(a)水平对糖尿病前期患者和糖尿病患者动脉粥样硬化性心血管疾病（ASCVD）事件的影响。
我们纳入了截至2023年5月的英文回顾性研究，探讨高Lp(a)水平与糖尿病、糖尿病前期或血糖正常人群心血管结局之间的联系。研究来源于PubMed、Scopus和谷歌学术，重点关注详细的人群和结局数据。我们排除了存在重大方法学问题、数据质量低、关键信息缺失、重复以及非人类受试者的研究。我们纳入了关于Lp(a)与心血管结局的高质量回顾性研究，使用纽卡斯尔-渥太华量表（NOS）等偏倚风险工具来确保数据完整性，并通过讨论解决差异。采用二元随机效应模型估计合并风险比（HR）和95%置信区间（CI）。进行留一法敏感性分析。使用I统计量评估异质性。对于显示中度或高度异质性的结局，按随访持续时间或研究类型进行亚组分析。
三项研究共纳入了20271例糖尿病患者、糖尿病前期患者和非糖尿病患者。在我们的分析中，与Lp(a)<10mg/dL的非糖尿病患者相比，糖尿病前期患者[Lp(a)<10mg/dL（HR：1.40，95%CI：1.17 - 1.67），Lp(a)10 - 30mg/dL（HR：1.60，95%CI：1.30 - 1.96），Lp(a)>30mg/dL（HR：2.08，95%CI：1.49 - 2.90）]和糖尿病患者[Lp(a)<10mg/dL（HR：2.42，95%CI：1.97 - 2.98），Lp(a)10 - 30mg/dL（HR：2.26，95%CI：1.64 - 3.12），Lp(a)>30mg/dL（HR：4.17，95%CI：3.24 - 5.37）]中，随着Lp(a)水平升高，ASCVD风险增加，差异具有统计学意义（P<0.01）。
高Lp(a)（>30mg/dL）与糖尿病患者和糖尿病前期患者更多的ASCVD事件相关。Lp(a)<30mg/dL，强调了Lp(a)在风险分层和干预中的临床重要性。
