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

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American journal of preventive cardiology Pub Date : 2024-09-01 DOI:10.1016/j.ajpc.2024.100783
Pamela L. Alebna MD, MPH
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引用次数: 0

摘要

治疗领域心血管疾病/心血管疾病风险因素背景现有证据表明,无论高敏 C 反应蛋白(hs-CRP)水平如何,脂蛋白(a)(Lp(a))升高都会增加发生重大不良心血管事件(MACE)的风险。然而,一些研究在一级预防人群和二级预防人群之间得出了不同的结果。我们对评估 Lp(a) 和 hs-CRP 升高导致 MACE 风险的研究进行了系统回顾(PROSPERO CRD4202345109)。主要结果是低水平(<2 毫克/升)和高水平(≥2 毫克/升)hs-CRP 患者 Lp(a) 与 MACE 之间相关性的总危险比 (HR)。我们对一级和二级预防人群进行了亚组分析。鉴于研究的异质性较大,我们采用了随机效应模型。结果 在系统综述中确定了七项研究,并将其纳入荟萃分析。汇总样本总数为 558914 人。女性的平均比例为 37%,整个群体的加权平均年龄为 58.9 岁。在脂蛋白(a)升高的人群中,低hs-CRP组和高hs-CRP组的MACE风险均显著增加,汇总危险比(HR)分别为1.24(95% CI:1.10-1.41)和1.33(95% CI:1.19-1.49)。在一级预防人群中,低hs-CRP组和高hs-CRP组的汇总HR分别为1.33(95% CI:1.06-1.66)和1.43(95% CI:1.13-1.82),亚组差异不显著(P=0.65)。我们的分析证实,在不同的 hs-CRP 水平下,Lp(a)升高会显著增加 MACE 风险,这强调了它在一级和二级预防人群中的相关性。
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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.
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来源期刊
American journal of preventive cardiology
American journal of preventive cardiology Cardiology and Cardiovascular Medicine
CiteScore
6.60
自引率
0.00%
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0
审稿时长
76 days
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