{"title":"脂蛋白(a)对主要不良心血管事件的预后价值与 c 反应蛋白的关系 - 系统综述和荟萃分析","authors":"Pamela L. Alebna MD, MPH","doi":"10.1016/j.ajpc.2024.100783","DOIUrl":null,"url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Existing evidence supports an increased risk of Major Adverse Cardiovascular Events (MACE) with elevated lipoprotein(a) (Lp(a)) regardless of high sensitivity C-reactive protein (hs-CRP) levels. However, some studies have presented divergent results between primary and secondary prevention populations. A meta-analysis could yield a more definitive estimation of the joint influence of these biomarkers on MACE risk.</div></div><div><h3>Methods</h3><div>We performed a systematic review of studies evaluating the risk of MACE with elevated Lp(a) and hs-CRP (PROSPERO CRD4202345109). The primary outcome was the pooled hazard ratio (HR) of the association between Lp(a) and MACE among individuals with low (<2mg/L) and high (≥2 mg/L) hs-CRP levels. We performed a subgroup analysis in primary and secondary prevention populations. A random effects model was used given the wide heterogeneity in studies.</div></div><div><h3>Results</h3><div>A total of seven studies were identified in the systematic review and included in the meta-analysis. The overall pooled sample comprised 558,914 individuals. The mean proportion of females was 37% and the weighted mean age for the entire cohort was 58.9 years. In individuals with elevated Lp(a), the risk of MACE was significantly increased across both low and high hs-CRP groups, with pooled hazard ratios (HR) of 1.24 (95% CI: 1.10–1.41) and 1.33 (95% CI: 1.19–1.49), respectively. In the primary prevention population, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06–1.66) and 1.43 (95% CI: 1.13–1.82), respectively, with a nonsignificant subgroup difference (P=0.65). The corresponding HR for the secondary prevention population was 1.10 (95% CI: 1.03–1.18) and 1.31 (95% CI: 1.09–1.57), respectively, with a non-significant subgroup difference (P=0.34) (Figure).</div></div><div><h3>Conclusions</h3><div>Our analysis confirms that elevated Lp(a) significantly elevates MACE risk across varying hs-CRP levels, underlining its relevance in both primary and secondary prevention cohorts.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100783"},"PeriodicalIF":4.3000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"PROGNOSTIC VALUE OF LIPOPROTEIN(A) FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS IN RELATION TO C-REACTIVE PROTEIN - A SYSTEMATIC REVIEW AND META-ANALYSIS\",\"authors\":\"Pamela L. Alebna MD, MPH\",\"doi\":\"10.1016/j.ajpc.2024.100783\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Existing evidence supports an increased risk of Major Adverse Cardiovascular Events (MACE) with elevated lipoprotein(a) (Lp(a)) regardless of high sensitivity C-reactive protein (hs-CRP) levels. However, some studies have presented divergent results between primary and secondary prevention populations. A meta-analysis could yield a more definitive estimation of the joint influence of these biomarkers on MACE risk.</div></div><div><h3>Methods</h3><div>We performed a systematic review of studies evaluating the risk of MACE with elevated Lp(a) and hs-CRP (PROSPERO CRD4202345109). The primary outcome was the pooled hazard ratio (HR) of the association between Lp(a) and MACE among individuals with low (<2mg/L) and high (≥2 mg/L) hs-CRP levels. We performed a subgroup analysis in primary and secondary prevention populations. A random effects model was used given the wide heterogeneity in studies.</div></div><div><h3>Results</h3><div>A total of seven studies were identified in the systematic review and included in the meta-analysis. The overall pooled sample comprised 558,914 individuals. The mean proportion of females was 37% and the weighted mean age for the entire cohort was 58.9 years. In individuals with elevated Lp(a), the risk of MACE was significantly increased across both low and high hs-CRP groups, with pooled hazard ratios (HR) of 1.24 (95% CI: 1.10–1.41) and 1.33 (95% CI: 1.19–1.49), respectively. In the primary prevention population, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06–1.66) and 1.43 (95% CI: 1.13–1.82), respectively, with a nonsignificant subgroup difference (P=0.65). The corresponding HR for the secondary prevention population was 1.10 (95% CI: 1.03–1.18) and 1.31 (95% CI: 1.09–1.57), respectively, with a non-significant subgroup difference (P=0.34) (Figure).</div></div><div><h3>Conclusions</h3><div>Our analysis confirms that elevated Lp(a) significantly elevates MACE risk across varying hs-CRP levels, underlining its relevance in both primary and secondary prevention cohorts.</div></div>\",\"PeriodicalId\":72173,\"journal\":{\"name\":\"American journal of preventive cardiology\",\"volume\":\"19 \",\"pages\":\"Article 100783\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of preventive cardiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S266666772400151X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of preventive cardiology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S266666772400151X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
PROGNOSTIC VALUE OF LIPOPROTEIN(A) FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS IN RELATION TO C-REACTIVE PROTEIN - A SYSTEMATIC REVIEW AND META-ANALYSIS
Therapeutic Area
ASCVD/CVD Risk Factors
Background
Existing evidence supports an increased risk of Major Adverse Cardiovascular Events (MACE) with elevated lipoprotein(a) (Lp(a)) regardless of high sensitivity C-reactive protein (hs-CRP) levels. However, some studies have presented divergent results between primary and secondary prevention populations. A meta-analysis could yield a more definitive estimation of the joint influence of these biomarkers on MACE risk.
Methods
We performed a systematic review of studies evaluating the risk of MACE with elevated Lp(a) and hs-CRP (PROSPERO CRD4202345109). The primary outcome was the pooled hazard ratio (HR) of the association between Lp(a) and MACE among individuals with low (<2mg/L) and high (≥2 mg/L) hs-CRP levels. We performed a subgroup analysis in primary and secondary prevention populations. A random effects model was used given the wide heterogeneity in studies.
Results
A total of seven studies were identified in the systematic review and included in the meta-analysis. The overall pooled sample comprised 558,914 individuals. The mean proportion of females was 37% and the weighted mean age for the entire cohort was 58.9 years. In individuals with elevated Lp(a), the risk of MACE was significantly increased across both low and high hs-CRP groups, with pooled hazard ratios (HR) of 1.24 (95% CI: 1.10–1.41) and 1.33 (95% CI: 1.19–1.49), respectively. In the primary prevention population, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06–1.66) and 1.43 (95% CI: 1.13–1.82), respectively, with a nonsignificant subgroup difference (P=0.65). The corresponding HR for the secondary prevention population was 1.10 (95% CI: 1.03–1.18) and 1.31 (95% CI: 1.09–1.57), respectively, with a non-significant subgroup difference (P=0.34) (Figure).
Conclusions
Our analysis confirms that elevated Lp(a) significantly elevates MACE risk across varying hs-CRP levels, underlining its relevance in both primary and secondary prevention cohorts.