The association of lipoprotein(a) and coronary artery calcium in asymptomatic patients: a systematic review and meta-analysis.

Autor:	Martignoni FV; Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute, 920 East 28th Street, Minneapolis, MN 55407, USA., Rl Júnior JE; Department of Medicine, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil., Marques IR; Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain., Gomes C; Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil., Moreira VCS; Department of Medicine, University Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil., de Souza IAF; Department of Medicine, Petrópolis Medical School, Petrópolis, Brazil., Miyawaki IA; Department of Medicine, Federal University of Paraná, Curitiba, Brazil., Silva CH; Department of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil., do Amaral Neto AB; Department of Internal Medicine, Central Montana Medical Center, Lewistown, USA., Padrão EMH; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, USA., Cardoso R; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA., de Vasconcellos HD; Department of Anesthesia and Critical Care, Johns Hopkins University Medicine, Baltimore, USA., Miedema M; Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute, 920 East 28th Street, Minneapolis, MN 55407, USA.
Jazyk:	angličtina
Zdroj:	European journal of preventive cardiology [Eur J Prev Cardiol] 2024 Apr 18; Vol. 31 (6), pp. 732-741.
DOI:	10.1093/eurjpc/zwae043
Abstrakt:	Aims: Lipoprotein(a) [Lp(a)] is an atherogenic lipid particle associated with increased risk for coronary heart disease (CHD) events. Coronary artery calcium (CAC) score is a tool to diagnose subclinical atherosclerosis and guide clinical decision-making for primary prevention of CHD. Studies show conflicting results concerning the relationship between Lp(a) and CAC in asymptomatic populations. We conducted a meta-analysis to evaluate the association of Lp(a) and CAC in asymptomatic patients. Methods and Results: We systematically searched PubMed, Embase, and Cochrane until April 2023 for studies evaluating the association between Lp(a) and CAC in asymptomatic patients. We evaluated CAC > 0 Agatston units, and CAC ≥ 100. Lp(a) was analysed as a continuous or dichotomous variable. We assessed the association between Lp(a) and CAC with pooled odds ratios (OR) adopting a random-effects model. A total of 23 105 patients from 18 studies were included in the meta-analysis with a mean age of 55.9 years, 46.4% female. Elevated Lp(a) increased the odds of CAC > 0 [OR 1.31; 95% confidence intervals (CI) 1.05-1.64; P = 0.02], CAC ≥100 (OR 1.29; 95% CI 1.01-1.65; P = 0.04; ), and CAC progression (OR 1.43; 95% CI 1.20-1.70; P < 0.01; ). For each increment of 1 mg/dL in Lp(a) there was a 1% in the odds of CAC > 0 (OR 1.01; 95% CI 1.01-1.01; P < 0.01). Conclusion: Our findings of this meta-analysis suggest that Lp(a) is positively associated with a higher likelihood of CAC. Higher Lp(a) levels increased the odds of CAC >0. These data support the concept that Lp(a) is atherogenic, although with high heterogeneity and a low level of certainty. Protocol Registration: CRD42023422034. Key Findings: Asymptomatic patients with elevated Lp(a) had 31% higher chances of having any coronary calcification (CAC > 0) and 29% higher chances of having more advanced calcification (CAC > 100). It increased the chances of having progression of coronary calcification over time by 43%. For each 1 mg/dL of Lp(a) there was an increment of 1% chance of having coronary calcification. Competing Interests: Conflict of interest: All authors report no relationships that could be construed as a conflict of interest. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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