急性心肌梗死后脂蛋白（a）与主要不良心血管事件的关联：队列研究的荟萃分析
The Association of Lipoprotein(a) with Major Adverse Cardiovascular Events after Acute Myocardial Infarction: A Meta-Analysis of Cohort Studies.
作者信息
Liu Huiruo, Wang Liangshan, Wang Hong, Hao Xing, Du Zhongtao, Li Chenglong, Hou Xiaotong
机构信息
Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
出版信息
Rev Cardiovasc Med. 2025 May 15;26(5):27376. doi: 10.31083/RCM27376. eCollection 2025 May.
BACKGROUND
Despite evidence suggesting a link between lipoprotein(a) (Lp(a)) and the occurrence of acute myocardial infarction (AMI), the relationship regarding prognoses related to AMI remains unclear. This meta-analysis was conducted to summarize the association between Lp(a) and the risks of major adverse cardiovascular events (MACEs) among populations surviving AMI.
METHODS
We searched PubMed, Embase, Web of Science, MEDLINE, and Cochrane Library databases until February 14, 2024. Cohort studies reporting multivariate-adjusted hazard ratios (HRs) for the correlation of Lp(a) with MACEs in AMI populations were identified. The Lp(a) level was analyzed using categorical and continuous variables. Subgroup analyses were conducted based on gender, type of AMI, diabetic and hypertensive status. Publication bias was assessed using funnel plots. A random-effect model was utilized to pool the results.
RESULTS
In total, 23 cohorts comprising 30,027 individuals were recruited. In comparison to those categorized with the lowest serum Lp(a), individuals in the highest category showed higher risks of MACEs after AMI (HR: 1.05, 95% confidence interval (CI): 1.01-1.09, = 0.006). Similar findings were exhibited when Lp(a) was analyzed as a continuous variable (HR: 1.14, 95% CI: 1.02-1.26, = 0.02). Subgroup analyses indicated that this correlation persisted significantly among females (HR: 1.23, = 0.005), diabetes mellitus (DM) (HR: 1.39, = 0.01), hypertension (HR: 1.36, < 0.00001), ST-segment elevation myocardial infarction (STEMI) (HR: 1.03, = 0.04), non-STEMI (HR: 1.40, = 0.03), and long-term (>1 year) MACE (HR: 1.41, = 0.0006) subgroups.
CONCLUSIONS
Higher Lp(a) levels might be an independent indicator for MACE risks after AMI, especially among female populations with DM and/or hypertension, and more suitable for evaluating long-term MACEs.
THE PROSPERO REGISTRATION
CRD42024511985, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024511985.
背景
尽管有证据表明脂蛋白(a)[Lp(a)]与急性心肌梗死(AMI)的发生之间存在联系，但Lp(a)与AMI相关预后的关系仍不清楚。本荟萃分析旨在总结Lp(a)与AMI存活人群中主要不良心血管事件(MACE)风险之间的关联。
方法
我们检索了截至2024年2月14日的PubMed、Embase、Web of Science、MEDLINE和Cochrane图书馆数据库。纳入报告了Lp(a)与AMI人群中MACE相关性的多变量调整风险比(HR)的队列研究。使用分类变量和连续变量分析Lp(a)水平。根据性别、AMI类型、糖尿病和高血压状态进行亚组分析。使用漏斗图评估发表偏倚。采用随机效应模型汇总结果。
结果
共纳入23个队列，包含30,027名个体。与血清Lp(a)水平最低的人群相比，Lp(a)水平最高的人群在AMI后发生MACE的风险更高(HR：1.05，95%置信区间(CI)：1.01-1.09，P = 0.006)。将Lp(a)作为连续变量分析时也有类似结果(HR：1.14，95%CI：1.02-1.26，P = 0.02)。亚组分析表明，这种相关性在女性(HR：1.23，P = 0.005)、糖尿病(DM)(HR：1.39，P = 0.01)、高血压(HR：1.36，P < 0.00001)、ST段抬高型心肌梗死(STEMI)(HR：1.03，P = 0.04)、非STEMI(HR：1.40，P = 0.03)以及长期(>1年)MACE(HR：1.41，P = 0.0006)亚组中均显著存在。
结论
较高的Lp(a)水平可能是AMI后MACE风险的独立指标,尤其是在患有DM和/或高血压的女性人群中，更适合评估长期MACE。
PROSPERO注册编号：CRD{42024511985}，https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024511985 。
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