Aspirin use in patients with elevated lipoprotein(a): Impact on cardiovascular events and bleeding

IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Current Problems in Cardiology Pub Date : 2024-08-25 DOI:10.1016/j.cpcardiol.2024.102827
Walter Masson , Leandro Barbagelata , Juan Patricio Nogueira
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Abstract

The role of aspirin in cardiovascular primary prevention remains controversial. There are physiological reasons to explore its potential benefits in patients with high levels of lipoprotein(a) [Lp(a)], mainly due to its antifibrinolytic properties and interactions with platelets. The primary objective of this systematic review was to evaluate the cardiovascular benefits and bleeding risks associated with aspirin use in patients who have elevated Lp(a) levels but no history of cardiovascular disease. This systematic review was conducted following PRISMA guidelines. We performed a literature search to identify studies assessing the cardiovascular benefits and bleeding risks of aspirin use in patients with elevated Lp(a) levels (or a related genetic variant) who have no history of cardiovascular disease. Five studies (49,871 individuals) were considered for this systematic review. Three studies assessed the impact of aspirin use in relation to genetic variants associated with elevated Lp(a) levels (SNP rs379822), while the remaining two studies directly measured plasma levels of Lp(a). The endpoints evaluated varied among the studies. Overall, the findings consistently show that carriers of the apolipoprotein(a) variant or patients with Lp(a) levels > 50 mg/dL experience a reduction in cardiovascular risk with aspirin use. No significant bleeding issues were observed, although such events were reported in only two studies. This systematic review suggests that aspirin use in patients with elevated Lp(a) levels and no prior cardiovascular history may reduce cardiovascular risk. The available data on bleeding risk is insufficient.

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脂蛋白(a)升高患者使用阿司匹林:对心血管事件和出血的影响。
阿司匹林在心血管一级预防中的作用仍存在争议。探讨阿司匹林对脂蛋白(a)[Lp(a)]水平高的患者的潜在益处有其生理原因,主要是由于阿司匹林的抗纤维蛋白溶解特性以及与血小板的相互作用。本系统综述的主要目的是评估脂蛋白(a)水平升高但无心血管疾病史的患者服用阿司匹林对心血管的益处和出血风险。本系统综述遵循 PRISMA 指南进行。我们进行了文献检索,以确定评估无心血管疾病史的脂蛋白(a)水平升高(或相关基因变异)患者服用阿司匹林对心血管的益处和出血风险的研究。本系统综述考虑了五项研究(49,871 人)。其中三项研究评估了阿司匹林的使用对与脂蛋白(a)水平升高相关的基因变异(SNP rs379822)的影响,其余两项研究则直接测量了血浆中的脂蛋白(a)水平。各项研究评估的终点各不相同。总体而言,研究结果一致表明,载脂蛋白(a)变异体携带者或脂蛋白(a)水平大于 50 毫克/分升的患者服用阿司匹林可降低心血管风险。尽管只有两项研究报告了出血事件,但未观察到明显的出血问题。本系统综述表明,脂蛋白(a)水平升高且无心血管病史的患者服用阿司匹林可降低心血管风险。有关出血风险的现有数据尚不充分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Current Problems in Cardiology
Current Problems in Cardiology 医学-心血管系统
CiteScore
4.80
自引率
2.40%
发文量
392
审稿时长
6 days
期刊介绍: Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.
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