AUTHOR=Wang Guochun , Xia Maoyin , Liang Cai , Pu Feng , Liu Sitai , Jia Dongxia 

TITLE=Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1362893

DOI=10.3389/fcvm.2024.1362893

ISSN=2297-055X

ABSTRACT=Background: Elevated lipoprotein (a) level was recognized as an independent risk factor for significant adverse cardiovascular events in acute coronary syndrome (ACS) patients. Despite this recognition, the consensus in the literature regarding the prognostic significance of elevated lipoprotein (a) in ACS was also limited. Consequently, we conducted a thorough systematic review and meta-analysis to evaluate the prognostic relevance of elevated lipoprotein (a) level in individuals diagnosed with ACS. Methods and results: A thorough literature review was conducted by systematically searching PubMed, Embase, and Cochrane databases until September 2023. This review specifically examined cohort studies exploring the prognostic implications of elevated lipoprotein (a) level in relation to major adverse cardiovascular events (MACE), including death, stroke, non-fatal myocardial infarction (MI), and coronary revascularization, in patients with ACS. The meta-analysis utilized aggregated multivariable hazard ratios (HR) and their respective 95% confidence intervals (CI) to evaluate prognostic implications between high and low lipoprotein (a) levels (the cut-off of high lipoprotein (a) level varies from 12.5 to 60 mg/dL). Among 18,168 patients in the identified studies, elevated lipoprotein (a) was independently associated with increased MACE risk (HR 1.26; 95% CI 1.17-1.35, P <0.00001) and all-cause mortality (HR 1.36; 95% CI 1.05-1.76, P=0.02) in ACS patients. In summary, elevated lipoprotein (a) levels independently forecast MACE and all-cause mortality in ACS patients. Assessing lipoprotein (a) levels appears promising for risk stratification in ACS, offering valuable insights for tailoring secondary prevention strategies. Myocardial)) OR (Infarctions, Myocardial)) OR (Myocardial Infarctions)) OR (Cardiovascular Stroke)) OR (Cardiovascular Strokes)) OR (Stroke, Cardiovascular)) OR (Strokes, Cardiovascular)) OR (Myocardial Infarct)) OR (Infarct, Myocardial)) OR (Infarcts, Myocardial)) OR (Myocardial Infarcts)) OR (Heart Attack)) OR (Heart Attacks)))) OR (("Acute Coronary Syndrome"[Mesh]) OR ((((((Acute Coronary Syndrome) OR (Acute Coronary Syndromes)) OR (Coronary Syndrome, Acute))  OR (Syndrome, Acute Coronary)) OR (Syndromes, Acute Coronary)))) AND (((((" Lipoprotein(a) ") OR OR ("Lipoprotein (a-)")). The exhaustive search methodology is outlined in Supplementary Table S2. Additionally, a thorough manual review of reference lists from all eligible studies was undertaken. Two investigators independently performed the search and assessment of included studies.Any discrepancies in the literature search were resolved through consensus after careful deliberation.