Palaiodimou Lina, Melanis Konstantinos, Stefanou Maria-Ioanna, Theodorou Aikaterini, Giannopoulos Sotirios, Lambadiari Vaia, Sousa Diana Aguiar de, Sacco Simona, Katan Mira, Siasos Gerasimos, Tsivgoulis Georgios
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany.
J Stroke. 2025 May;27(2):161-168. doi: 10.5853/jos.2024.04623. Epub 2025 May 31.
Lipoprotein(a) [Lp(a)] is a lipoprotein structurally similar to low-density lipoprotein and is considered a genetically determined risk factor for cardiovascular disease. Although Lp(a) has been linked to ischemic stroke, its role in secondary stroke prevention, particularly in stroke recurrence, remains unclear.
A systematic search of MEDLINE and Scopus databases was conducted to identify randomized controlled trials (RCTs) and observational studies reporting Lp(a) levels in patients with ischemic stroke or transient ischemic attack. The primary outcome was stroke recurrence, and secondary outcomes included poor functional outcome, all-cause mortality, and recurrent vascular events. Pooled odds ratios (ORs) were calculated using a random-effects model.
A total of 12 studies, including one RCT post hoc analysis and 11 observational studies, comprising 17,903 patients (mean age 63 years, 38% female), were included. Elevated Lp(a) levels were significantly associated with increased stroke recurrence (OR: 1.69; 95% confidence interval [CI]: 1.09-2.63; P=0.020) and poor functional outcome (OR: 2.09; 95% CI: 1.40-3.11; P<0.001). No significant associations were found between Lp(a) levels and all-cause mortality (OR: 2.20; 95% CI: 0.89-5.43; P=0.088) or recurrent vascular events (OR: 2.66; 95% CI: 0.95-7.44; P=0.063).
Elevated Lp(a) levels are linked to increased stroke recurrence and poor functional outcome in stroke patients. Lp(a) may represent a novel therapeutic target in secondary stroke prevention in addition to a promising biomarker.
脂蛋白(a)[Lp(a)]是一种结构上与低密度脂蛋白相似的脂蛋白，被认为是心血管疾病的遗传决定风险因素。尽管Lp(a)与缺血性卒中有关，但其在二级卒中预防中的作用，尤其是在卒中复发方面，仍不明确。
对MEDLINE和Scopus数据库进行系统检索，以识别报告缺血性卒中或短暂性脑缺血发作患者Lp(a)水平的随机对照试验(RCT)和观察性研究。主要结局是卒中复发，次要结局包括功能结局不良、全因死亡率和复发性血管事件。采用随机效应模型计算合并比值比(OR)。
共纳入12项研究，包括1项RCT事后分析和11项观察性研究，共17903例患者(平均年龄63岁，38%为女性)。Lp(a)水平升高与卒中复发增加(OR：1.69；95%置信区间[CI]：1.09 - 2.63；P = 0.020)和功能结局不良(OR：2.09；95%CI：1.40 - 3.11；P < 0.001)显著相关。未发现Lp(a)水平与全因死亡率(OR：2.20；95%CI：0.89 - 5.43；P = 0.088)或复发性血管事件(OR：2.66；95%CI：0.95 - 7.44；P = 0.063)之间存在显著关联。
Lp(a)水平升高与卒中患者卒中复发增加和功能结局不良有关。Lp(a)除了是一种有前景的生物标志物外，可能代表二级卒中预防中的一个新的治疗靶点。
