Association of Lipoprotein(a) With Major Adverse Cardiovascular Events Across hs-CRP

Pamela L. Alebna, MD, MPH; Chin Yip Han, MD; Mathew Ambrosio, MS; Gwyneth Kong, MD; John W. Cyrus, BA; Kayla Harley, BA; Le Kang, PhD; Aeron M. Small, MD, MTR; Parag Chevli, MBBS, MS; Harpreet Bhatia, MD, MAS; Nicholas Chew, MD; Fadi N. Salloum, PhD; Dave L. Dixon, PharmD; Antonio Abbate, MD, PhD; Pradeep Natarajan, MD, MMSc; Michael D. Shapiro, DO, MCR; Anurag Mehta, MD

JACC: Advances (Dec 2024)

Association of Lipoprotein(a) With Major Adverse Cardiovascular Events Across hs-CRP

Pamela L. Alebna, MD, MPH,
Chin Yip Han, MD,
Mathew Ambrosio, MS,
Gwyneth Kong, MD,
John W. Cyrus, BA,
Kayla Harley, BA,
Le Kang, PhD,
Aeron M. Small, MD, MTR,
Parag Chevli, MBBS, MS,
Harpreet Bhatia, MD, MAS,
Nicholas Chew, MD,
Fadi N. Salloum, PhD,
Dave L. Dixon, PharmD,
Antonio Abbate, MD, PhD,
Pradeep Natarajan, MD, MMSc,
Michael D. Shapiro, DO, MCR,
Anurag Mehta, MD

Affiliations

Pamela L. Alebna, MD, MPH: Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
Chin Yip Han, MD: Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Mathew Ambrosio, MS: Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
Gwyneth Kong, MD: Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
John W. Cyrus, BA: Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
Kayla Harley, BA: Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
Le Kang, PhD: Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
Aeron M. Small, MD, MTR: Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
Parag Chevli, MBBS, MS: Division of Cardiology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
Harpreet Bhatia, MD, MAS: Division of Cardiology, University of California San Diego, California, USA
Nicholas Chew, MD: Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Fadi N. Salloum, PhD: Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
Dave L. Dixon, PharmD: Department of Pharmacotherapy & Outcomes Science, VCU School of Pharmacy, Richmond, Virginia, USA
Antonio Abbate, MD, PhD: Division of Cardiology, Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia, USA
Pradeep Natarajan, MD, MMSc: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
Michael D. Shapiro, DO, MCR: Division of Cardiology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
Anurag Mehta, MD: Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Address for correspondence: Dr Anurag Mehta, Preventive Cardiology, VCU Health Pauley Heart Center, Internal Medicine, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, PO Box 980036, Richmond, Virginia 23298, USA.

Journal volume & issue: Vol. 3, no. 12
p. 101409

Abstract

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Background: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. The relationship between Lp(a) and major adverse cardiovascular events (MACE) in the context of high-sensitivity C-reactive protein (hs-CRP) levels remains controversial due to conflicting results from previous studies. Objectives: This systematic review and meta-analysis aimed to clarify the association between Lp(a) and risk of MACE across different hs-CRP levels in both primary and secondary prevention settings. Methods: We performed a systematic review by searching MEDLINE (PubMed), Embase (Ovid), Cochrane CENTRAL (Wiley), and Web of Science (Clarivate) from their inception to February 2024. Eligible studies reported the association of Lp(a) with MACE stratified by hs-CRP level. Data extraction and quality assessment were systematically conducted. Meta-analyses used random-effects models to compute pooled HRs for individuals with low (<2 mg/L) and high (≥2 mg/L) hs-CRP levels. Subgroup analyses were performed in primary and secondary prevention populations. Results: Nine publications encompassing 11 studies that involved 562,301 participants met the inclusion criteria. The mean proportion of females was 39.9% and the weighted mean age for the entire cohort was 61.2 years. Elevated Lp(a) was significantly associated with MACE risk in both low and high hs-CRP groups, with pooled HR of 1.26 (95% CI: 1.11-1.42) and 1.33 (95% CI: 1.20-1.47), respectively. In the primary prevention group, 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 (subgroup difference, P = 0.65). The corresponding HRs for the secondary prevention population were 1.13 (95% CI: 1.00-1.27) and 1.31 (95% CI: 1.12-1.52), respectively (subgroup difference P = 0.13). Conclusion: Elevated Lp(a) is associated with an increased risk of MACE independent of hs-CRP levels in both primary and secondary prevention populations.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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